Association Between Critical Limb Ischemia, the Society for Vascular Surgery Wound, Ischemia and Foot Infection (WIfI) Classification System and Arterial Stiffness.

BACKGROUND: Arterial stiffness analysis has been done to classify cardiovascular risk. The aim of this article is to analyze whether the group of patients with chronic limb-threatening ischemia (CLTI) has higher arterial stiffness indices than controls. The secondary objectives are to assess whether patients with advanced stages of Wound, Ischemia, and foot Infection (WIfI) classification have high levels of arterial stiffness, through multiple linear regressions to analyze whether the ankle-brachial index (ABI) and other variables are predictive of arterial stiffness. METHODS: We conducted a cross-sectional study with 66 patients with CLTI and 66 age- and sex-matched controls using brachial artery oscillometry. Hemodynamic and arterial stiffness measurements, clinical characteristics, laboratory data, and stages of WIfI classification were compared between the groups CLTI and controls. Through multiple linear regression, we identified predictors of pulse wave velocity (PWV) and augmentation index normalized to 75 beats/min (AIx@75). RESULTS: Patients with CLTI had PWV (11.8 ± 1.6 m/sec vs. 10.0 ± 1.8 m/sec, P < 0.01) and AIx@75 (29.2 ± 9.8% vs.18. ± 10.35%, P < 0.01) higher than controls. In the multiple regression model, there was influence of age (ß = 0.17, P < 0.01), antiplatelet therapy (ß = -0.15, P = 0.04), peripheral systolic pressure (ß = 0.03, P < 0.01), and clustered WIfI stages 3 and 4 (ß = 0.17, P = 0.02) of benefit of revascularization on PWV. Multiple regression analysis identified diabetes (ß = 7.51, P < 0.01) and the degree of ischemia measured by ABI (ß = -23.89, P < 0.01) as predictors of elevated AIx@75. WIfI stages 3 and 4 of estimate risk of amputation at 1 year predicts a high AIx@75 (ß = 9.77, P < 0.001) compared with stages 1 and 2. CONCLUSIONS: The degree of ischemia in CLTI patients determined by the ABI is associated with elevated arterial stiffness as measured by the AIx@75. Advanced WIfI stages were predictors of elevated PWV and AIx@75.