Search is Powered by Google
Follow us on:
Follow our health news on Twitter
Follow Our News on Facebook
Personalization
login | register
Vascular News

Leaders In Vascular And Endo-Vascular Community Debate Bypass Versus Infrapopliteal Balloon Angioplasty

Main Category: Vascular
Also Included In: Medical Devices / Diagnostics;  Cardiovascular / Cardiology
Article Date: 24 Nov 2008 - 4:00 PDT

email icon email to a friend   printer icon printer friendly   write icon view / write opinions   rate icon rate article


Current Article Ratings:

Patient / Public:not yet rated

Health Professional:not yet rated

Article Opinions: 0 posts

Long-Term (5-Year) Results Of BASIL Trial Show "Open Surgery First" To Be Superior To "Endovascular Treatment First" For Critical Limb Ischemia Severe leg ischemia (SLI), characterized by rest/night pain and tissue loss (ulceration, gangrene), leads to significant morbidity and mortality as well as to use of considerable health and social care resources in developed and developing countries.

There is an ongoing debate as to whether such patients are best treated by bypass surgery or balloon angioplasty. As presented at the VEITHsymposium by Andrew W. Bradbury, M.D., FRESEd, Professor of Surgery at the University of Birmingham and Consultant Vascular Surgeon for the Heart of England NHS Trust in Birmingham, United Kingdom, the UK-based multi-center Bypass versus Angioplasty in Severe Ischemia of the Leg (BASIL) trial is the first and only randomized controlled trial to compare the clinical and cost-effectiveness of surgical bypass and balloon angioplasty for SLI.

The initial results of this trial, presented in 2005, hinted that there was an apparent advantage of surgery.

Now, the patients have now been followed for a further 2½ years and this longer term data can be reassessed.

Dr. Bradbury stated, "The principal and most important finding to come from the final BASIL trial analysis is that the clinical superiority of surgery after 2 years from randomization has been confirmed in terms of overall, but not amputation free, survival."

There was overall no significant difference in total hospital costs between the two treatment arms after 2-3 years. This suggests that a bypass surgery first strategy should normally be regarded as the treatment of choice for SLI patients who are considered likely to live longer than two years.

As about three-quarters of the bypasses in the BASIL trial were constructed with autogenous vein, the strength of this recommendation is greatest in those patients where vein is available as a bypass conduit.

However, the BASIL trial also suggests that those SLI patients who are unlikely to live two years are probably better served by an angioplasty first strategy. This is because such patients are unlikely to survive to reap the longer term benefits of surgery, may be more likely to suffer surgical morbidity and mortality, and because angioplasty is significantly less expensive than surgery in the short term.

But for everyone else but high risk patients or those with no vein, surgery is the better bet, concludes Dr. Bradbury, because of a more complete and durable revascularization, fewer readmissions/interventions, and better aftercare (graft surveillance, medical therapy).

VEITH SYMPOSIUM - New York, November 19th to 23rd

Now in its fourth decade, VEITH SYMPOSIUM provides vascular surgeons, interventional radiologists, interventional cardiologists and other vascular specialists with a unique and exciting format to learn the most current information about what is new and important in the treatment of vascular disease. The 5-day event features rapid-fire presentations from world renowned vascular specialists with emphasis on the latest advances, changing concepts in diagnosis and management, pressing controversies and new techniques.

VEITHsymposium is sponsored by Cleveland Clinic, Cleveland, OH.

www.veithsymposium.org

Source
Pauline T. Mayer
www.ptmhcm.com




Personalized Homepage Weekly Newsletters Daily News Alerts
Hemophilia Opioid Induced Constipation Pneumococcal Disease ADHD Anxiety Asthma Atrial Fibrillation Autism Cancer Diabetes Lung Cancer Lupus Medicare / Medicaid Obesity and BMI Pancreatic Cancer Stem Cells All 'What Is...' Articles

Ophthalmology Urology
About Us News Licensing Free Website Feeds Free Tools & Content Tell a Friend Accessibility Help / FAQ Article Submission Links Contact Us

add medical news today to your facebook
medical news gadget

Please fill in our survey

Swine Flu Image

Swine Flu Updates

- Latest Swine Flu News
- What is Swine Flu?
- Map Of H1N1 Outbreaks
- Swine Flu - Top 20 FAQ
- Daily Email News Alerts
Stick with Medical News Today for the latest news updates on swine flu.


These are the most read articles from this news category for the last 6 months:
Top Article Star
What Is Low Blood Pressure? What Is Hypotension?
03 Aug 2009
Low blood pressure is also known as hypotension. For millions of people who suffer from hypertension (high blood pressure) hypotension may seem great. If symptoms are mild hypotension usually requires no treatment...


Cholesterol Management image Cholesterol Management

Each year more than a million Americans have heart attacks. High cholesterol can form a blockage in the arteries and lead to heart disease. Lifestyle changes and adherence to a treatment plan are important for cholesterol management...

Vascular Health and Atherosclerosis image Vascular Health and Atherosclerosis

Vascular health refers to the well-being of the heart and the blood vessels. Certain risk factors increase the likelihood that atherosclerosis, a disease of the arteries, will occur. Early detection and knowing your risk factors are keys to improving your health...

View more videos...