Contemporary (2009-2014) clinical outcomes after femoropopliteal bypass surgery for chronic limb threatening ischemia are inferior to those reported in the UK Bypass versus Angioplasty for Severe Ischaemia of the Leg (BASIL) trial (1999-2004)

Abstract

clinical outcomes after femoro-popliteal bypass surgery for chronic limb threatening ischaemia are inferior to those reported in the UK Bypass versus Angioplasty for Severe Ischaemia of the Leg (BASIL) trial (1999-2004)',

A Comparison of Contemporary Clinical Outcomes Following Femoro-Popliteal Plain Balloon Angioplasty and Bypass Surgery for Chronic Limb Threatening Ischemia

“…In patients undergoing BS, both survival (HR 1.66, 95%CI 1.00-2.74, P ¼ 0.05) and limb-based outcomes (MALE, HR 1.93, 95%CI 1.15-3.22, P ¼ 0.01) were significantly worse in the contemporary series. 17 Survival in those undergoing contemporary endovascular intervention was inferior to that observed in BASIL-1 (HR ¼ 0.58, 95% CI: 0.44 In this study those treated with BS had significantly worse FP Bollinger and GLASS scores, suggesting an increased burden of disease in those patients treated with BS. Interestingly there was not a significant difference in disease burden compared to those treated in BASIL-1.…”

“…Specifically, current and other previously published data do not support the mantra that improvements in endovascular technologies and expertise have translated into better longerterm clinical outcomes for patients with CLTI since patients were randomized in BASIL-1. 6,7,[16][17][18] Although comparison between RCT data (BASIL-1) and contemporary data are limited we have shown in our previous publications that contemporary clinical outcomes in both PBA and BS in the FP segment are significantly worse now than those observed in BASIL-1. In patients undergoing BS, both survival (HR 1.66, 95%CI 1.00-2.74, P ¼ 0.05) and limb-based outcomes (MALE, HR 1.93, 95%CI 1.15-3.22, P ¼ 0.01) were significantly worse in the contemporary series.…”

“…However, a critical internal review of our practice and outcomes suggests that our growing enthusiasm for an endovascular first revascularization strategy where possible in patients presenting with CLTI, based on these considerations, and also a belief that the results of endovascular revascularization have improved since BASIL-1, may have been misguided. [16][17][18] The aim of the present study, therefore, was to further investigate whether the results of BASIL-1 are still relevant to our current practice by comparing femoro-popliteal (FP) BS with PBA in a series of CLTI patients treated in our unit between 2009 and 2014, 10 years after BASIL-1.…”

Editor's Choice – Relationship Between Global Limb Anatomic Staging System (GLASS) and Clinical Outcomes Following Revascularisation for Chronic Limb Threatening Ischaemia in the Bypass Versus Angioplasty in Severe Ischaemia of the Leg (BASIL)-1 Trial

“…Other published data from this group and other groups also suggest that the results of revascularisation have not, in fact, improved since BASIL-1. 9,10 The previously widely expressed confidence that better patency rates following the use of paclitaxel based drug coated balloons (DCB) and drug eluting stents (DES) would translate into better clinical outcomes has now been shown to be seriously misplaced. So, although BASIL-1 interventions were performed some time ago, the weight of current evidence strongly indicate that BASIL-1 outcomes remain relevant to current practice.…”

Impact of Dialysis Vintage and Renal Biomarkers on Mortality in Dialysis-Dependent Patients With Critical Limb Ischemia Undergoing Revascularization

“…Clinical outcomes of patients with critical limb ischemia (CLI), including wound healing, limb salvage, and survival, are improved by revascularization. [1][2][3] However, it is still challenging to treat dialysis-dependent patients with CLI by both endovascular therapy (EVT) and surgical reconstruction, even with technological advancements. 4,5 The prevalence of dialysis-dependent patients is increasing in Japan; therefore, the proportion of patients with CLI in Japanese clinical studies (generally 30%-55%) is higher than that in other countries.…”