WIfI Classification System

The Society for Vascular Surgery (SVS) Lower Extremity Guidelines Committee realized there was a need for a classification system for threatened limbs that encompassed the full spectrum of disease, as all existing classification systems fell short in this regard.  So, they created the WIfI (Wound, Ischemia, and foot Infection) Classification System to categorize these three major risk factors leading to amputation3Mills JL, Conte MS, Armstrong DG, et al. The Society for Vascular Surgery Lower Extremity Threatened Limb Classification System: Risk stratification based on Wound, Ischemia, and foot Infection (WIfI). J Vasc Surg. 2014;59(1):220034.e1-2..  It contains the key limb status elements needed to gauge the severity of limb threat4Conte MS, Bradbury AW, Kolh P, et. al, Global Vascular Guidelines on the Management of Chronic Limb-Threatening Ischemia. Eur J Vasc Endovasc Surg. 2019 Jul;58(1S):S1-S109.e33. doi: 10.1016/j.ejvs.2019.05.006., which enables physicians to predict amputation risk more accurately.  It also to be able to compare progress between patient groups undergoing different therapies, thereby improving treatment over time.

The Ischemia category of the WIfI classification system (grades shown in the table below) is focused on measuring the hemodynamics/perfusion of the patient, using several different diagnostic measurements.  Recommended tests include ABI, toe pressure (TP), tcpO2, SPP, and PVR.  Of special note is that TP measurements are recommended in all diabetic patients and those with elevated ankle pressures (ABI > 1.3) due to vessel calcification.

Grade ABI Ankle systolic pressure (mmHg) Toe pressure, tcpO2 (mmHg)
0 ≥0.80 >100 ≥60
1 0.6-0.79 70-100 40-59
2 0.4-0.59 50-70 30-39
3 ≤0.39 <50 <30

The PeriFlux 6000 Combined System is the only system available that can perform all the SVS WIfI recommended tests.  As the market leader for toe pressure systems, Perimed’s primary strength mirrors the emphasis that WIfI places on this particular test.  The PeriFlux 6000 Combined System is the WIfI diagnostic system.

Click below to get the SVS WIfI Calculator App, introduced by the Society for Vascular Surgery, the European Society for Vascular Surgery and the World Federation of Vascular Societies.

References:

  1. Mills JL, Conte MS, Armstrong DG, et al. The Society for Vascular Surgery Lower Extremity Threatened Limb Classification System: Risk stratification based on Wound, Ischemia, and foot Infection (WIfI). J Vasc Surg. 2014;59(1):220034.e1-2.
  2. Conte MS, Bradbury AW, Kolh P, et. al, Global Vascular Guidelines on the Management of Chronic Limb-Threatening Ischemia. Eur J Vasc Endovasc Surg. 2019 Jul;58(1S):S1-S109.e33. doi: 10.1016/j.ejvs.2019.05.006.

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