| Bypass versus Angioplasty in Severe Ischaemia of the Leg (BASIL) and the (hoped for) dawn of evidence-based treatment for advanced limb ischemia. | |
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MedLine Citation:
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PMID: 20435263 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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Michael S Conte |
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Publication Detail:
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Type: Journal Article; Review |
Journal Detail:
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Title: Journal of vascular surgery Volume: 51 ISSN: 1097-6809 ISO Abbreviation: J. Vasc. Surg. Publication Date: 2010 May |
Date Detail:
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Created Date: 2010-05-03 Completed Date: 2010-05-27 Revised Date: 2012-10-03 |
Medline Journal Info:
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Nlm Unique ID: 8407742 Medline TA: J Vasc Surg Country: United States |
Other Details:
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Languages: eng Pagination: 69S-75S Citation Subset: IM |
Copyright Information:
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Copyright (c) 2010 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved. |
Affiliation:
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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.:
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ISRCTN/ISRCTN45398889 |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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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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