Current opinion on the role of the foot perfusion in limb amputation risk assessment

Clinical Hemorheology and Microcirculation
Romeo Martini

Abstract

The most important and consulted guidelines dealing with not healing foot ulcers suggest the measurement the foot perfusion (FP) to exclude the critical limb ischemia (CLI) because of the high risk of limb amputation. But the recommended cut-off values of FP fail to include all the heterogeneity of patients of the real-life with a not healing ulcer. Often these patients are diabetics with a moderate PAD but high level of infection. To meet this goal, in 2014, the Society for Vascular Surgery has published the "Lower Extremity Threatened Limb Classification System: Risk stratification based on Wound, Infection, and foot Ischemia (WIfI)." This new classification system changed the criteria of assessment of limb amputation risk replacing the single cut-off value role, with a combination of a spectrum of perfusion values along with graded infection and dimension levels of skin ulcers. The impact of this new classification system was remarkable so to propose the substitution of the CLI with the new Critical limb-threatening ischemia (CLTI) that seems to define the limb amputation risk more realistically.

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