Clinical Presentation
Applied
Type
ModificationConfidence
92%
Created
Apr 26, 2026
Evidence
1 source
Rationale
The stale guideline citation acc 2025 b has been replaced with the superseding 2026 ACC/AHA Lower Extremity Peripheral Artery Disease guideline ACC/AHA per the stale guideline replacement instructions. Both citations support the same claim regarding WIfI classification and limb salvage optimization, so only the newer superseding guideline is retained. The existing citation key ACC/AHA is already listed among the chapter's existing keys, confirming this is the correct replacement target.
Evidence
Content Changes
removedadded
Risk stratification and staging systems guide clinical decision-making in chronic limb-threatening ischemia (CLTI). The Wound, Ischemia, and foot Infection (WIfI) classification grades limb threat and estimates amputation risk and revascularization benefit, a strategy emphasized by the American College of CardiologyCardiology/American (ACC)Heart Association (ACC/AHA) for the management of patients with diabetes to optimize limb salvage [@mills2014, @acc2025-b].@acc2026]. The Global Limb Anatomic Staging System (GLASS) stages anatomic complexity of femoropopliteal and infrapopliteal disease. The PLAN framework (Patient risk, Limb severity [WIfI], ANatomic complexity [GLASS]) integrates these systems to guide revascularization strategy selection, conduit choice, and perfusion targets [@conte2019]. Systematic clinical staging is also critical for value-based medicine to ensure the appropriate allocation of imaging resources and minimize diagnostic misallocation [@raskin2025].