A recent trial evaluates two different revascularization strategies for treating chronic limb-threatening ischemia. One option significantly reduces major amputations and deaths.
The treatment of chronic limb-threatening ischemia (CLTI) – a severe form of atherosclerosis affecting the arteries below the knee – has taken a significant leap forward. Data recently published in The Lancet has unveiled a promising new treatment approach that outperforms traditional methods in preventing major amputation and death in CLTI patients. The persistent poor prognosis is caused on the one hand by the multimorbidity of the affected persons, but on the other hand by a very heterogeneous to insufficient diagnostic and therapeutic management.
The study, known as the Bypass versus Angioplasty in Severe Ischemia of the Leg (BASIL-2) trial, presents a comparative analysis of two revascularisation strategies aiming to restore limb blood flow in patients suffering from CLTI. Patients from the UK, Sweden, and Denmark participated in this randomised controlled trial and were divided into two groups: one receiving vein bypass (VB) treatment, the traditional procedure, and the other recieved a „best endovascular treatment“ (BET) strategy.
Preliminary results indicate that patients who received the vein bypass treatment were a third more likely to require a major amputation or succumb to the illness compared to those in the BET group. The BET strategy predominantly used plain balloon angioplasty, selectively incorporating stent use where necessary.
Chief investigator of the BASIL-2 trial, Professor Andrew Bradbury, Professor of Vascular Surgery at the University of Birmingham, comments on the results: „Chronic limb-threatening ischemia has consistently presented a poor prognosis, with optimal strategies for restoring limb blood flow being incompletely defined. The BASIL-2 trial, being only the third published randomised controlled trial on CLTI, and the only one specifically targeting patients needing intervention on arteries below the knee, marks a major milestone.“
Image source: Startaê Team, Unsplash
