The Society for Vascular Surgery Lower Extremity Threatened Limb Classification System: Risk stratification based on Wound, Ischemia, and foot Infection (WIfI)
The Society for Vascular Surgery Lower Extremity Threatened Limb Classification System: Risk stratification based on Wound, Ischemia, and foot Infection (WIfI)
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DOI：
10.1016/j.jvs.2013.08.003
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发表时间：
2014-01-01
影响因子：
4.3
通讯作者：
Andros, George
中科院分区：
文献类型：
--
作者：
Mills, Joseph L., Sr.;Conte, Michael S.;Andros, George
1982年首次定义的严重肢体缺血旨在描述主要由于慢性缺血导致下肢受威胁的患者亚组。原作者的意图是将糖尿病患者排除或单独分析。方丹和卢瑟福系统已被用于通过将患者亚分类为两组来对截肢风险和从血运重建中获益的可能性进行分类：缺血性静息痛和组织损失。由于过去40年来人口统计学的变化，特别是糖尿病发病率的急剧上升和血运重建技术的迅速发展，使用这些现有的分类系统对肢体受威胁的患者进行有意义的结局分析变得越来越困难。特别是在糖尿病患者中，肢体威胁是广泛疾病谱的一部分。灌注只是结果的一个决定因素;伤口范围和感染的存在和严重程度也极大地影响对肢体的威胁。因此，血管外科学会下肢功能指南委员会承担了创建一个新的受威胁下肢分类的任务，以反映这些重要的考虑因素。我们将这一新的框架称为血管外科学会下肢危险肢体分类系统。风险分层基于影响截肢风险和临床管理的三个主要因素：伤口、缺血和足部感染（WIfI）。该分类系统的实施旨在允许对这种具有挑战性但异质性的人群中各种形式治疗的结局进行更有意义的分析。
Critical limb ischemia, first defined in 1982, was intended to delineate a subgroup of patients with a threatened lower extremity primarily because of chronic ischemia. It was the intent of the original authors that patients with diabetes be excluded or analyzed separately. The Fontaine and Rutherford Systems have been used to classify risk of amputation and likelihood of benefit from revascularization by subcategorizing patients into two groups: ischemic rest pain and tissue loss. Due to demographic shifts over the last 40 years, especially a dramatic rise in the incidence of diabetes mellitus and rapidly expanding techniques of revascularization, it has become increasingly difficult to perform meaningful outcomes analysis for patients with threatened limbs using these existing classification systems. Particularly in patients with diabetes, limb threat is part of a broad disease spectrum. Perfusion is only one determinant of outcome; wound extent and the presence and severity of infection also greatly impact the threat to a limb. Therefore, the Society for Vascular Surgery Lower Extremity Guidelines Committee undertook the task of creating a new classification of the threatened lower extremity that reflects these important considerations. We term this new framework, the Society for Vascular Surgery Lower Extremity Threatened Limb Classification System. Risk stratification is based on three major factors that impact amputation risk and clinical management: Wound, Ischemia, and foot Infection ( WIfI). The implementation of this classification system is intended to permit more meaningful analysis of outcomes for various forms of therapy in this challenging, but heterogeneous population.