Document Detail


Bypass versus Angioplasty in Severe Ischaemia of the Leg (BASIL) and the (hoped for) dawn of evidence-based treatment for advanced limb ischemia.
MedLine Citation:
PMID:  20435263     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The Bypass versus Angioplasty in Severe Ischemia of the Leg (BASIL) trial is the only randomized controlled trial (RCT) to date comparing open surgical bypass with endovascular therapy for severe limb ischemia (SLI). In their initial 2005 publication, the BASIL investigators reported that the main clinical outcomes (overall survival and amputation-free survival) were no different at 2 years after randomization to angioplasty-first or bypass-first revascularization strategies. However, beyond 2 years there appeared to be a benefit for open bypass surgery, providing impetus for an extension study. The final analysis of the long-term outcomes from BASIL is now presented in a set of articles that are reviewed in this commentary. The benefit of initial randomization to open surgery for patients surviving > or =2 years (70% of the BASIL cohort) was confirmed. When outcomes were analyzed by treatment received, patients who had received prosthetic bypass grafts (25% of the surgical arm) fared much more poorly than those treated with a vein bypass. Patients who underwent surgical bypass after an initial failed angioplasty also fared significantly worse than those who were treated initially with bypass surgery. Health-related quality of life measures and costs were not significantly different overall. There are many controversies surrounding the BASIL trial and its interpretation, which are reviewed herein. These include the choice of study population, end points examined, and the nature of procedures performed. The BASIL trial confirms the primacy of open surgical bypass with vein for most patients with SLI and raises questions about the sequelae of failed endovascular interventions. Further multicenter trials are needed to address the large gap in evidence for treatment selection in this patient population.
Authors:
Michael S Conte
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Journal of vascular surgery     Volume:  51     ISSN:  1097-6809     ISO Abbreviation:  J. Vasc. Surg.     Publication Date:  2010 May 
Date Detail:
Created Date:  2010-05-03     Completed Date:  2010-05-27     Revised Date:  2012-10-03    
Medline Journal Info:
Nlm Unique ID:  8407742     Medline TA:  J Vasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  69S-75S     Citation Subset:  IM    
Copyright Information:
Copyright (c) 2010 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.
Affiliation:
Division of Vascular and Endovascular Surgery and the Heart and Vascular Center, University of California-San Francisco, 400 Parnassus Ave., San Francisco, CA 94143, USA. Michael.conte@ucsfmedctr.org
Data Bank Information
Bank Name/Acc. No.:
ISRCTN/ISRCTN45398889
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Amputation
Angioplasty, Balloon* / adverse effects,  mortality
Blood Vessel Prosthesis Implantation
Constriction, Pathologic
Evidence-Based Medicine
Female
Great Britain
Humans
Ischemia / mortality,  radiography,  surgery,  therapy*
Lower Extremity / blood supply*
Male
Middle Aged
Multicenter Studies as Topic*
Peripheral Vascular Diseases / mortality,  radiography*,  surgery,  therapy*
Practice Guidelines as Topic
Prospective Studies
Quality of Life
Randomized Controlled Trials as Topic*
Reoperation
Research Design
Saphenous Vein / transplantation
Severity of Illness Index
Time Factors
Treatment Outcome
Vascular Surgical Procedures* / adverse effects,  mortality

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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