A comparison of data of two US and UK studies, regarding morbidity after endovascular and contemporary infrainguinal open surgery for critical limb ischaemia, was presented at the VEITHsymposium by Dr Glenn M LaMuraglia, Massachusetts General Hospital, Boston. According to LaMuraglia, the conclusion was that the differences in results between the two countries most likely reflect different patient cohorts rather than different surgical outcomes.
The American study concluded that endovascular results have significantly lower 30-day morbidity-mortality and, evaluating this period’s risk/benefit for CLI patients, the percutaneous therapy was recommended as initial treatment for infrainguinal reconstruction. The study also highlights a lower wound complication rate in NSQIP (9.7%) vs. BASIL (23%).
Professor Andrew Bradbury, principal investigator of the BASIL (Bypass versus Angioplasty in Severe Limb Ischaemia of the Leg) trial, conducted in the UK, favoured surgery as first-line treatment. However, it is suggested that angioplasty should be considered first-line for treatment for high-risk patients (those with a predicted survival of less than two years) and for patients with no usable veins. The conclusion of BASIL was that, in the short-time, angioplasty is less morbid and such patients will not live to enjoy the long-term benefits of the surgery. Surgery only benefits those patients that can be expected to survive the operation according to Bradbury. Dr LaMuraglia’s commented after the BASIL trial that is impossible to define those patients who would benefit from the improved survival of bypass surgery after two years.
