Bypass versus Angioplasty in Severe Ischaemia of the Leg (BASIL) trial: Health-related quality of life outcomes, resource utilization, and cost-effectiveness analysis

Abstract

Adopting a BSX-first strategy for patients with severe limb ischemia does result in a modest increase in hospital costs, with a small positive but insignificant gain in disease-specific and generic HRQOL. However, the real-world choice between BSX-first and BAP-first revascularization strategies for severe limb ischemia due to infrainguinal disease cannot depend on costs alone and will require a more comprehensive consideration of individual patient preferences conditioned by expectations of survival and other health outcomes.

Lower extremity bypass vs endovascular therapy for young patients with symptomatic peripheral arterial disease

“…2 There are two RCTs, including mostly claudicants with superficial femoral artery (SFA) occlusions, which suggest that surgical bypass gives better results than the endovascular approach. 23,24 Another RCT 25,26 that included a large variety of lesions and mixed indications observed similar outcome after both approaches (Table II).…”

“…22 The BASIL trial also addressed this issue in the short-term and long-term follow-up data, with no significant improvement in quality of life found between the PTA and bypass groups. 23 In summary, infrainguinal treatment for symptomatic PAD with PTA offers a lower rate of perioperative morbidity and mortality than bypass for patients with claudication and CLI, resulting in a faster return to normal daily activity.…”

“…But when comparable patients are analyzed, bypass seems to give a better result. 23,24,29 These data are far less cited than those suggesting noninferiority of endovascular methods (Table II). The findings of the BASIL trial suggest that whether to perform bypass or PTA first for CLI due to infrainguinal disease depends on life expectancy.…”

Critical Limb Ischemia: Current Trends and Future Directions

“…It may also be due to a lowering threshold for endovascular interventions as reflected by an increase of hospital admissions for endovascular interventions for claudication (ie, increase from 10–31% to 26–43% of the PAD‐related hospital admissions in 2001 and 2008, respectively) 69. The larger need for reinterventions in endovascular therapy also becomes apparent from cost‐effectiveness analyses that focused on the comparison of endovascular strategies with open surgery 70, 71. These studies show an early benefit of endovascular strategies over open procedures but this benefit is lost after ≈1 year, due to reinterventions in the endovascular group.…”

Comparison of Clinical Outcome After Bypass Surgery vs. Endovascular Therapy for Infrainguinal Artery Disease in Patients With Critical Limb Ischemia

“…17 Many patients in the EVT group were readmitted to hospital for repeat revascularization and this might be 1 of the reasons for the increased cost in the late phase. In recent years, drug-eluting stents and drug-coated balloons for infrainguinal lesion have been shown to have preventive effects against restenosis.…”