SIR 2024
Arterial Interventions and Peripheral Arterial Disease (PAD)
Kavenpreet Bal, MS
Medical Student
Kaiser Permanente Bernard J. Tyson School of Medicine
Financial relationships: Full list of relationships is listed on the CME information page.
Daniel Burke, IV, BS (he/him/his)
Medical Student
Kaiser Permanente School of Medicine
Financial relationships: Full list of relationships is listed on the CME information page.
Sophia M. Durney, BS (she/her/hers)
Medical Student
Kaiser Permanente Bernard J Tyson School of Medicine
Financial relationships: Full list of relationships is listed on the CME information page.
Anthony R. Zamary, MS
Medical Student
Kaiser Permanente School of Medicine
Disclosure information not submitted.
Alok Bhatt, MD
Assistant Program Director of Vascular and Interventional Integrated Residency
Kaiser Permanente physician
Financial relationships: Full list of relationships is listed on the CME information page.
(1) Review the evidence comparing the effectiveness of surgical bypass to endovascular stenting in patients with critical limb ischemia. (2) Review outcomes among the Bypass versus Angioplasty for Severe Ischaemia of the Leg (BASIL)-1, BASIL-2, and Best Surgical Therapy in Patients with CLI (BEST-CLI) clinicals trials while assessing their quality of evidence. (3) Create evidence-based suggestions on how to select patients with CLI for endovascular stent therapy versus surgical bypass therapy. This exhibit will: Review the BASIL-1, BASIL-2, and BEST-CLI Randomized Controlled Trials while evaluating revascularization-associated morbidity and mortality Analytically and narratively summarize the outcomes of the trials, using pooled data when appropriate, to identify the safety and efficacy of surgical bypass vs endovascular stenting in patients with CLI. Identify the limitations of these three studies and provide guidance for future research. There is variability in patient selection for endovascular stenting versus bypass surgery. BASIL-1, BASIL-2, and BEST-CLI are studies that have strived to compare the efficacy of lower extremity revascularization through surgical bypass vs endovascular stenting for patients with CLI. This educational exhibit summarizes the quality and outcomes of these studies, and pools results together to identify differences in morbidity and mortality. Additionally, it will identify which patients may be more suited for a specific revascularization strategy.
Background: Critical limb ischemia (CLI) is a significant source of morbidity and limb loss in patients with severe chronic lower extremity peripheral arterial disease (PAD) {1-4}. Lower extremity revascularization, broadly encompassing surgical therapy and endovascular therapy, serve to restore distal blood flow to the affected limb, minimizing ischemic damage and preventing amputation {1,3}. Decisions between surgical and endovascular revascularization are based on a myriad of factors, such as anatomy, comorbidities, and distribution of disease. This educational exhibit will review the key findings and limitations of three hallmark randomized control trials that evaluate the difference between surgical and endovascular revascularizations: The Bypass versus Angioplasty for Severe Ischaemia of the Leg (BASIL)-1, BASIL-2, and Best Surgical Therapy in Patients with CLI (BEST-CLI) {4-6}. This educational exhibit serves to evaluate the quality and limitations of these three studies, while pooling data for analyses when appropriate.
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