BEST-CLI

Best Endovascular versus Best Surgical Therapy in Patients with Critical Limb Ischemia

Patient / Population Intervention / Exposition Comparaison Critère de jugement

In 1,830 patients with chronic limb-threatening ischaemia and infra-inguinal disease, surgical bypass reduced major adverse limb events or death compared with endovascular therapy, but only in those with an adequate single-segment great saphenous vein.

1 830

Schéma

Open-label RCT with two parallel cohorts

Critère

Composite of major adverse limb event or death from any cause

Pertinence

RésultatCohort 1 (adequate saphenous vein, n=1,434): 42.6 % vs 57.4 % (HR 0.68; 95 % CI 0.59–0.79; p<0.001). Cohort 2 (alternative conduit, n=396): 42.8 % vs 47.7 % (HR 0.79; 95 % CI 0.58–1.06; p=0.12).

Farber A, Menard MT, et al. N Engl J Med. 2022;387(25):2305-2316. 10.1056/NEJMoa2207899

Discussion et critique

Enrolment took nine years, so modern below-knee endovascular technology is under-represented, and only cohort 1 is positive. It nevertheless supplies the strongest randomised evidence that a good saphenous vein should push the choice toward bypass in chronic limb-threatening ischaemia.