Peripheral Artery Disease and WIfI Classification: Scoping Review with ☸SAIMSARA

The aim of this review is to synthesize contemporary evidence regarding the prognostic utility, clinical integration, and predictive accuracy of the Wound, Ischemia, and foot Infection (WIfI) classification system in patients with peripheral artery disease (PAD) and chronic limb-threatening ischemia (CLTI) across diverse clinical settings and populations. The review utilises 90 original studies with 1187547 total participants (topic deduplicated ΣN). This evidence map suggests that the WIfI classification has a consistent role in PAD and CLTI risk stratification, with one-year major amputation increasing from 15% in stage 1 to 55% in stage 4 in a large real-world cohort. Across the mapped literature, higher stages were also associated with worse survival, poorer wound healing, and less favorable post-revascularization trajectories, while stage 3 or 4 disease showed particularly strong signals for cardiac and limb-related risk. The review further supports a practical role for combining WIfI with anatomic frameworks such as Global Limb Anatomic Staging System (GLASS) and, when needed, adjunctive ischemia measures such as transmetatarsal pressure to refine decision-making in complex limb salvage care. At the same time, the evidence base indicates important heterogeneity, including settings in which prognostic discrimination was limited, especially in some conservatively managed or tissue-loss cohorts. Clinically, these findings support more routine and structured use of WIfI staging to guide multidisciplinary planning, surveillance intensity, and revascularization discussions. Future research should prioritize prospective, standardized studies that test how best to integrate WIfI with anatomic staging, alternative perfusion metrics, and key comorbidity profiles to improve prediction across diverse PAD populations.