What Is the Best Treatment for Chronic Limb-Threatening Ischemia?

A large clinical trial suggests that vascular surgery should be preferred in patients with a suitable in situ vein.

Chronic limb-threatening ischemia (CLTI) is one of the most severe complications of peripheral-artery disease (PAD), and — in the most extreme cases — can lead to amputation or death. Revascularization is a mainstay of therapy, but there is no consensus as to whether surgical revascularization or endovascular therapy is the optimal initial approach.

In the BEST-CLI trial (NCT02060630), investigators randomized 1830 patients with CLTI and infrainguinal PAD who were suitable candidates for both surgical and endovascular revascularization to undergo one or the other procedure. Randomization was stratified based on whether the patient was anatomically suitable for in situ venous bypass (cohort 1; n=1434) or required use of an alternative venous …

Reviewing Author

David J. Cohen, MD, MSc

Disclosures

Consultant/Advisory BoardMedtronic; Edwards Lifesciences; Abbott Vascular; Boston Scientific; St. Francis Hospital

Speaker’s BureauBoston Scientific; ZOLL Medical

Grant/Research SupportEdwards Lifesciences; Abbott Vascular; Boston Scientific; Corvia Medical; National Heart, Lung, and Blood Institute; Phillips, Inc.; St. Paul’s Hospital; V-Wave, Inc; ZOLL Medical; CathWorks, ANCORA

Editorial BoardsJACC; American Heart Journal; EuroIntervention; JSCAI; Structural Heart Journal

Leadership Positions in Professional SocietiesSociety of Thoracic Surgeons/American College of Cardiology TVT Registry (Co-Chair, Risk Model Development Committee); Cardiovascular Research Foundation (Co-Director, TCT Annual Meeting; Co-Director, New York Valves Annual Meeting)