ortho-trauma

WIfI Classification for Chronic Limb-Threatening Ischaemia

SVS (Society for Vascular Surgery) WIfI classification system for chronic limb-threatening ischaemia (CLTI). Grades Wound severity, Ischaemia, and foot Infection. Guides amputation risk and benefit of revascularisation.

Wound severity (W)*

Ischaemia (I) — Ankle-Brachial Index (ABI) or ankle systolic pressure*

Foot Infection (fI) — IDSA classification*

Score interpretation

Stage 1 — Low Amputation Risk 0–1

WIfI Stage 1 — low amputation risk; revascularisation benefit uncertain

→ Wound care; optimise cardiovascular risk factors; antiplatelet therapy; consider revascularisation if symptomatic ischaemia; monitor healing; podiatry input

Stage 2–3 — Moderate Risk 2–4

WIfI Stage 2–3 — moderate amputation risk; revascularisation may benefit

→ Vascular surgery referral; duplex ultrasound and/or CTA/MRA for revascularisation planning; treat infection aggressively (IV antibiotics); wound debridement; revascularisation likely beneficial — angioplasty or bypass per anatomy; MDT (vascular surgery, diabetology, podiatry, wound care)

Stage 4 — High Amputation Risk 5–9

WIfI Stage 4 — high amputation risk; revascularisation benefit high if feasible

→ Urgent vascular surgery review; admission for IV antibiotics and wound care; aggressive revascularisation attempt if anatomically possible; if not, primary amputation planning; MDT; rehabilitation/prosthetics team; patient goals-of-care discussion

Interpretation bands for the WIfI Classification. Apply clinical judgement and local guidance.

References

Mills JL 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):220–234.

Curated clinical cross-links plus same-class fallbacks.

Drugs

Pathways

Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.

Score interpretation

References

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