BASIL-2

Bypass versus Angioplasty for Severe Ischaemia of the Leg – 2

Paciente / Población Intervención / Exposición Comparación Desenlace

In 345 patients with chronic limb-threatening ischaemia requiring infra-popliteal revascularisation, a vein-bypass-first strategy worsened amputation-free survival compared with a best-endovascular-treatment-first strategy.

345

Diseño

Open-label, pragmatic phase-3 RCT

Desenlace

Amputation-free survival (above-ankle amputation or death from any cause)

Relevancia

ResultadoMajor amputation or death 63 % vs 53 % (adjusted HR 1.35; 95 % CI 1.02–1.80; p=0.037), driven mainly by more deaths in the bypass arm (53 % vs 45 %).

Bradbury AW, Moakes CA, et al. Lancet. 2023;401(10390):1798-1809. 10.1016/S0140-6736(23)00462-2

Discusión y crítica

Small, open-label and driven by all-cause rather than limb-related death, so the mechanism of harm is unclear. Read against BEST-CLI it produces the guideline's nuanced position: anatomy and conduit, not dogma, should decide bypass versus endovascular therapy.