Wednesday 26 April 2023
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CX 2023 OVERVIEW
BASIL-2: EXCLUSIVE UPDATE
DAY TWO
Aortic Consensus
Abdominal and Juxtarenal Aortic Wednesday, 08:00–18:00 Kensington 1
BASIL-2 points towards endovascular-first revascularisation strategy in CLTI patients
Superficial Venous & Lymphatic Consensus
Superficial Venous & Lymphatic Wednesday, 08:00–13:00 Kensington 2
Deep Venous Consensus
A question from Manj Gohel (Cambridge, United Kingdom) on what the CX audience should take back to their multidisciplinary team meetings from the firsttime presentation of BASIL-2 led chief investigator Andrew Bradbury (Birmingham, United Kingdom) to deliver the stark message: a patient who needs a below-the-knee revascularisation with or without a femoropopliteal revascularisation is likely to do better if they are treated with a best endovascular-first strategy rather than a vein bypass-first approach.
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n the BASIL-2 (Bypass versus angioplasty for severe ischaemia of the leg) trial of 345 patients with chronic limb-threatening ischaemia (CLTI), a best endovascular treatment-first revascularisation strategy was associated with better amputationfree survival than a vein bypass-first strategy in those who required an infrapopliteal repair—with or without a more proximal infrainguinal procedure. This result was largely driven by fewer deaths in the best endovascular treatment group. Bradbury, of the UniversityCXVASCULAR-APRIL-2023-225X58.pdf of Birmingham, presented1this key finding during a 07/04/2023 15:40:00 Podium First presentation yesterday morning. The results were
simultaneously published in The Lancet. “It all seems to be pointing towards attempting an endovascular procedure first and then if that does not work, doing something else—which could be more endovascular,” Bradbury said in response to Gohel. Alternatively, he added, this could be the point at which the vascular specialist switches over to a bypass approach. BASIL-2, however, “lends quite a lot of weight” to an endovascularfirst revascularisation strategy, “with all the caveats that we have to consider”. Bradbury, delivering the data for the first time during day one of CX 2023, revealed that 63% of patients randomised to a vein bypassfirst strategy of treatment underwent a major amputation or died during follow-up, compared to just 53% of those allotted to a best endovascular-first approach—BASIL-2’s primary outcome measure (adjusted hazard ratio 1.35, 95% confidence interval [CI] 1.02–1.08, p=0.037). “Essentially this means that, in this cohort, a vein bypass revascularisation strategy resulted in a 35% increased risk of amputation or death during the follow-up compared with a best Continued on page 2
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Deep Venous Wednesday, 13:30–18:00 Kensington 2
Acute Stroke Consensus
Acute Stroke Wednesday, 08:00–11:00 Admiral
Vascular Trauma Consensus
Vascular Trauma Wednesday, 11:00–13:00 Admiral