{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T12:50:01Z","timestamp":1792241401930,"version":"4.4.0"},"reference-count":31,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2023,2,1]],"date-time":"2023-02-01T00:00:00Z","timestamp":1675209600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Vasc Med"],"published-print":{"date-parts":[[2023,2]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>The Society for Vascular Surgery Threatened Limb Classification System (\u2018WIfI\u2019) is used to predict risk of limb loss and identify peripheral artery disease in patients with foot ulcers or gangrene. We estimated the diagnostic sensitivity of multiple clinical and noninvasive arterial parameters to identify chronic limb-threatening ischemia (CLTI).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We performed a single-center review of 100 consecutive patients who underwent angiography for foot gangrene or ulcers. WIfI stages and grades were determined for each patient. Toe, ankle, and brachial pressure measurements were performed by registered vascular technologists. CLTI severity was characterized using Global Limb Anatomic Staging System (GLASS stages) and angiosomes. Medial artery calcification in the foot was quantified on foot radiographs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>GLASS NA (not applicable), I, II, and III angiographic findings were seen in 21, 21, 23, and 35 patients, respectively. A toe\u2013brachial index &lt; 0.7 and minimum ipsilateral ankle\u2013brachial index &lt; 0.9 performed well in identifying GLASS II and III angiographic findings, with sensitivity rates 97.8% and 91.5%, respectively. The diagnostic accuracy rates of noninvasive measures peaked at 74.7% and 89.3% for identifying GLASS II\/III and GLASS I+ angiographic findings, respectively. The presence of medial artery calcification significantly diminished the sensitivity of most noninvasive parameters.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>The use of alternative noninvasive arterial testing parameters improves sensitivity for detecting PAD. Abnormal noninvasive results should suggest the need for diagnostic angiography to further characterize arterial anatomy of the affected limb. Testing strategies with better accuracy are needed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/1358863x221147945","type":"journal-article","created":{"date-parts":[[2023,2,9]],"date-time":"2023-02-09T23:48:37Z","timestamp":1675986517000},"page":"45-53","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":7,"title":["Lower-extremity pressure, staging, and grading thresholds to identify chronic limb-threatening ischemia"],"prefix":"10.1177","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9008-9819","authenticated-orcid":false,"given":"Justin Chin-Bong","family":"Choi","sequence":"first","affiliation":[{"name":"Michael E. DeBakey Department of Surgery, Division of Vascular Surgery and Endovascular Therapy, Baylor College of Medicine, Houston, TX, USA"},{"name":"Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jorge","family":"Miranda","sequence":"additional","affiliation":[{"name":"Michael E. DeBakey Department of Surgery, Division of Vascular Surgery and Endovascular Therapy, Baylor College of Medicine, Houston, TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erin","family":"Greenleaf","sequence":"additional","affiliation":[{"name":"Michael E. DeBakey Department of Surgery, Division of Vascular Surgery and Endovascular Therapy, Baylor College of Medicine, Houston, TX, USA"},{"name":"Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael S","family":"Conte","sequence":"additional","affiliation":[{"name":"Division of Vascular & Endovascular Surgery, University of California at San Francisco, San Francisco, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie D","family":"Gerhard-Herman","sequence":"additional","affiliation":[{"name":"Vascular Diagnostic Laboratory, Brigham and Women\u2019s Hospital, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"Sr","given":"Joseph L","family":"Mills","sequence":"additional","affiliation":[{"name":"Michael E. DeBakey Department of Surgery, Division of Vascular Surgery and Endovascular Therapy, Baylor College of Medicine, Houston, TX, USA"},{"name":"Baylor-St Luke\u2019s Medical Center, Houston, TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1019-8930","authenticated-orcid":false,"given":"Neal R","family":"Barshes","sequence":"additional","affiliation":[{"name":"Michael E. DeBakey Department of Surgery, Division of Vascular Surgery and Endovascular Therapy, Baylor College of Medicine, Houston, TX, USA"},{"name":"Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2023,2,9]]},"reference":[{"key":"bibr1-1358863X221147945","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2019.02.016"},{"key":"bibr2-1358863X221147945","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2013.08.003"},{"key":"bibr3-1358863X221147945","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2009.09.044"},{"key":"bibr4-1358863X221147945","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejvs.2019.03.040"},{"key":"bibr5-1358863X221147945","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2006.03.026"},{"key":"bibr6-1358863X221147945","doi-asserted-by":"publisher","DOI":"10.1016\/S0950-821X(05)80784-4"},{"key":"bibr7-1358863X221147945","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.107.763227"},{"key":"bibr8-1358863X221147945","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.116.003219"},{"key":"bibr9-1358863X221147945","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejvs.2013.11.011"},{"key":"bibr10-1358863X221147945","doi-asserted-by":"publisher","DOI":"10.1097\/01.prs.0000222582.84385.54"},{"key":"bibr11-1358863X221147945","doi-asserted-by":"publisher","DOI":"10.23736\/S0392-9590.17.03809-3"},{"key":"bibr12-1358863X221147945","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2012.10.129"},{"key":"bibr13-1358863X221147945","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.24370"},{"key":"bibr14-1358863X221147945","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2021.07.235"},{"key":"bibr15-1358863X221147945","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2011.07.011"},{"key":"bibr16-1358863X221147945","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.28.9.2206"},{"key":"bibr17-1358863X221147945","doi-asserted-by":"publisher","DOI":"10.1253\/circj.72.605"},{"key":"bibr18-1358863X221147945","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.20906"},{"key":"bibr19-1358863X221147945","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2006.04.075"},{"key":"bibr20-1358863X221147945","doi-asserted-by":"publisher","DOI":"10.1016\/0301-5629(96)00036-1"},{"key":"bibr21-1358863X221147945","doi-asserted-by":"publisher","DOI":"10.5999\/aps.2012.39.3.227"},{"key":"bibr22-1358863X221147945","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.24604"},{"key":"bibr23-1358863X221147945","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.43.6.905"},{"key":"bibr24-1358863X221147945","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2016.04.056"},{"key":"bibr25-1358863X221147945","doi-asserted-by":"publisher","DOI":"10.1016\/j.avsg.2010.12.025"},{"key":"bibr26-1358863X221147945","doi-asserted-by":"publisher","DOI":"10.1177\/0003319709348295"},{"key":"bibr27-1358863X221147945","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2008.06.005"},{"key":"bibr28-1358863X221147945","doi-asserted-by":"publisher","DOI":"10.1111\/dme.12309"},{"key":"bibr29-1358863X221147945","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2016.04.026"},{"key":"bibr30-1358863X221147945","doi-asserted-by":"publisher","DOI":"10.1177\/1358863X12445102"},{"key":"bibr31-1358863X221147945","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2021.06.478"}],"container-title":["Vascular Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/1358863X221147945","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/1358863X221147945","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/1358863X221147945","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T03:33:34Z","timestamp":1777692814000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/1358863X221147945"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,2]]},"references-count":31,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2023,2]]}},"alternative-id":["10.1177\/1358863X221147945"],"URL":"https:\/\/doi.org\/10.1177\/1358863x221147945","relation":{},"ISSN":["1358-863X","1477-0377"],"issn-type":[{"value":"1358-863X","type":"print"},{"value":"1477-0377","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,2]]}}}