Classificação WifI: o novo sistema de classificação da Society for Vascular Surgery para membros inferiores ameaçados, uma revisão de literatura

Cerqueira, Lorena de Oliveira; Duarte, Eliud Garcia; Barros, André Luis de Souza; Cerqueira, José Roberto; Araújo, Walter Junior Boim de

doi:10.1590/1677-5449.190070

Cited by 18 publications

(4 citation statements)

References 27 publications

(98 reference statements)

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“…We also found 52.8% of patients with IWGDF classification considered severe and 39.8% with grade IV WIfI, also severe, where the chance of amputation is about 23% in one year [ 8 ]. However, some studies observed that major amputation rates at stage II were the same or even higher than rates at stage III [ 13 , 14 , 15 , 16 ].…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, the Society for Vascular Surgery developed a new classification system that is based on the characteristics of the wound (W), on the degree of ischemia (I) and on the presence and severity of foot infection (fI) called Wound, Ischemia and foot Infection classification, or WIfI classification [ 7 ]. Grade IV of WIfI classification estimates 23% amputation risk in 1 year [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

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Microbiology of Diabetic Foot Infections in a Tertiary Care Hospital in São Paulo, Brazil

et al. 2022

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Diabetic foot infections (DFIs) are one of the causes of hospitalization in diabetic patients and, when this occurs, empirical antibiotic therapy is necessary. We have conducted a retrospective study of patients with DFI that required hospitalization to evaluate microbiologic profile and the susceptibility pattern of these infections. We evaluated 320 patients, of which 223 (69.7%) were male with a media age of 71 years with 276 isolates. Gram-positive bacteria were responsible for 188 (68.1%) of the isolates, while Gram-negative bacilli were responsible for 88 (31.9%). E. faecalis was the most prevalent pathogen, followed by S. aureus and coagulase negative Staphylococci. Among Gram-negative pathogens, P. aeruginosa was the most prevalent agent. Regarding the susceptibility profile, we found ampicillin-sensitive enterococci in 89% of the cases, oxacillin-sensitive S. aureus in 47%, but in coagulase-negative staphylococci, oxacillin was sensible only in 20%. The susceptibility profile of Gram-negatives was very good with 76% susceptibility of P. aeruginosa to ceftazidime and meropenem. The other prevalent Enterobacterales had great susceptibility to ceftazidime, piperacillin-tazobactam and 100% susceptibility to meropenem, with the exception of K. pneumoniae, which had 75% susceptibility to meropenem. Knowledge of microbiological profile and susceptibility patterns of patients with DFIs is useful to guide empirical therapy.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Microbiology of Diabetic Foot Infections in a Tertiary Care Hospital in São Paulo, Brazil

et al. 2022

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“…Hyperglycemia significantly contributes to the development of myopathy and microvascular disease, which determines muscle cell loss, endothelial dysfunction, and muscle fibrosis (Huysman and Mathieu 2009 ). The revascularization strategy is an effective y approach for CLI treatment (Cerqueira and Duarte 2020 ). Additionally, the outcome of revascularization in diabetic patients is not favorable, which increased the possibility of patients undergoing amputation (Al-Delaimy et al 2004 ).…”

Section: Introductionmentioning

confidence: 99%

The promotion action of AURKA on post-ischemic angiogenesis in diabetes-related limb ischemia

Bai

Liu

et al. 2023

Mol Med

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Background Diabetes-related limb ischemia is a challenge for lower extremity amputation. Aurora Kinase A (AURKA) is an essential serine/threonine kinase for mitosis, while its role in limb ischemia remains unclear. Method Human microvascular endothelial cells (HMEC-1) were cultured in high glucose (HG, 25 mmol/L d-glucose) and no additional growth factors (ND) medium to mimic diabetes and low growth factors deprivation as in vitro model. Diabetic C57BL/6 mice were induced by streptozotocin (STZ) administration. After seven days, ischemia was surgically performed by left unilateral femoral artery ligation on diabetic mice. The vector of adenovirus was utilized to overexpress AURKA in vitro and in vivo. Results In our study, HG and ND-mediated downregulation of AURKA impaired the cell cycle progression, proliferation, migration, and tube formation ability of HMEC-1, which were rescued by overexpressed AURKA. Increased expression of vascular endothelial growth factor A (VEGFA) induced by overexpressed AURKA were likely regulatory molecules that coordinate these events. Mice with AURKA overexpression exhibited improved angiogenesis in response to VEGF in Matrigel plug assay, with increased capillary density and hemoglobin content. In diabetic limb ischemia mice, AURKA overexpression rescued blood perfusion and motor deficits, accompanied by the recovery of gastrocnemius muscles observed by H&E staining and positive Desmin staining. Moreover, AURKA overexpression rescued diabetes-related impairment of angiogenesis, arteriogenesis, and functional recovery in the ischemic limb. Signal pathway results revealed that VEGFR2/PI3K/AKT pathway might be involved in AURKA triggered angiogenesis procedure. In addition, AURKA overexpression impeded oxidative stress and subsequent following lipid peroxidation both in vitro and in vivo, indicating another protective mechanism of AURKA function in diabetic limb ischemia. The changes in lipid peroxidation biomarkers (lipid ROS, GPX4, SLC7A11, ALOX5, and ASLC4) in in vitro and in vivo were suggestive of the possible involvement of ferroptosis and interaction between AUKRA and ferroptosis in diabetic limb ischemia, which need further investigation. Conclusions These results implicated a potent role of AURKA in diabetes-related impairment of ischemia-mediated angiogenesis and implied a potential therapeutic target for ischemic diseases of diabetes.

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“…The proposed risk stratification system is based on three main factors that influence amputation risk and clinical management: wound, ischemia, and foot infection (WIfI). Several studies have demonstrated the high clinical value of this classification; in particular, a strong correlation was demonstrated between the WIfI score, 1-year amputation-free survival, wound healing, and the need for limb revascularization [ 9 , 10 , 11 , 12 ]. With the advent of this classification system associated with continuous improvement in the innovations in PAD treatment, previous classifications rapidly became obsolete, and so did the previous hemodynamic cut-off of AP to define limb-threatening ischemia [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Chronic Limb-Threatening Ischemia and the Need for Revascularization

Berchiolli

Bertagna

Adami

et al. 2023

JCM

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Background: Patients presenting with critical limb-threatening ischemia (CLTI) have been increasing in number over the years. They represent a high-risk population, especially in terms of major amputation and mortality. Despite multiple guidelines concerning their management, it continues to be challenging. Decision-making between surgical and endovascular procedures should be well established, but there is still a lack of consensus concerning the best treatment strategy. The aim of this manuscript is to offer an overview of the contemporary management of CLTI patients, with a focus on the concept that evidence-based revascularization (EBR) could help surgeons to provide more appropriate treatment, avoiding improper procedures, as well as too-high-risk ones. Methods: We performed a search on MEDLINE, Embase, and Scopus from 1 January 1995 to 31 December 2022 and reviewed Global and ESVS Guidelines. A total of 150 articles were screened, but only those of high quality were considered and included in a narrative synthesis. Results: Global Vascular Guidelines have improved and standardized the way to classify and manage CLTI patients with evidence-based revascularization (EBR). Nevertheless, considering that not all patients are suitable for revascularization, a key strategy could be to stratify unfit patients by considering both clinical and non-clinical risk factors, in accordance with the concept of individual residual risk for every patient. The recent BEST-CLI trial established the superiority of autologous vein bypass graft over endovascular therapy for the revascularization of CLTI patients. However, no-option CLTI patients still represent a critical issue. Conclusions: The surgeon’s experience and skillfulness are the cornerstones of treatment and of a multidisciplinary approach. The recent BEST-CLI trial established that open surgical peripheral vascular surgery could guarantee better outcomes than the less invasive endovascular approach.

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Classificação WifI: o novo sistema de classificação da Society for Vascular Surgery para membros inferiores ameaçados, uma revisão de literatura

Cited by 18 publications

References 27 publications

Microbiology of Diabetic Foot Infections in a Tertiary Care Hospital in São Paulo, Brazil

Microbiology of Diabetic Foot Infections in a Tertiary Care Hospital in São Paulo, Brazil

The promotion action of AURKA on post-ischemic angiogenesis in diabetes-related limb ischemia

Chronic Limb-Threatening Ischemia and the Need for Revascularization

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