Contemporary (2009-2014) clinical outcomes after femoropopliteal bypass surgery for chronic limb threatening ischemia are inferior to those reported in the UK Bypass versus Angioplasty for Severe Ischaemia of the Leg (BASIL) trial (1999-2004)

• DOI: 10.1016/j.jvs.2018.08.197
• Publication Date: 2019-03-07T04:25:07Z
• Authors: Lewis Meecham; Matthew Popplewell; Gareth Bate; Smitaa Patel; Andrew W. Bradbury
• Keywords: Critical limb ischemia; Bypass surgery

BackgroundBypass surgery (BS) remains the gold standard revascularization strategy in patients with chronic limb-threatening ischemia (CLTI) owing to infrainguinal disease. The Bypass versus Angioplasty for Severe Ischaemia of Leg (BASIL)-1 trial showed that, CLTI who survived 2 years or more, BS resulted better clinical outcomes. Despite this finding, there has been an increasing trend toward endovascular-first approach CLTI. Our aim was investigate whether changes practice have impacted outcomes our unit 10 after BASIL-1.MethodsData underwent femoropopliteal (FP) BASIL-1 (1999-2004) were retrieved from case record forms. comparator contemporary series (CS) comprised all undergoing FP between 2009 and 2014. Demographic outcome data on CS collected prospectively hospital electronic notes. Anatomic patterns disease cohorts scored using Bollinger GLASS criteria. Statistical analysis performed SAS v9.4.ResultsThere 128 50 CS. Baseline age, gender, affected limb, diabetes prevalence similar, as days spent out 12 months length follow-up. more likely be current smokers (P = .000) had a higher creatinine .04). 30-day morbidity mortality (45.3% vs 22%; P .004). There no significant difference regard run-off (37.7 32.1; .167) IP (0 0; .390) scores, both groups having median two runoff vessels. Amputation-free survival (62% 28%; hazard ratio [HR], 1.86; 95% confidence interval [CI], 1.18-2.93; .007), limb salvage (85% 69%; HR, 2.31; CI, 1.14-4.68; .02), overall (69% 35%; 1.66; 1.00-2.74; .05) major adverse events (67% 47%; 1.93; 1.15-3.22; .01) significantly BASIL-1.ConclusionsAlthough lower, examined longer term worse group decade BASIL-1. Further research form prospective cohort studies randomized controlled trials is urgently required determine if reported herein are generalizable vascular surgical and, so, reasons these unexpected