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 to a friend   printer friendly   view / write opinions   rate article

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