February 2023 | Issue 97
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Maarit Venermo Abdominal aortic aneurysm screening
Profile: Jon Boyle page 16
CX SYMPOSIUM 2023
CX to spotlight audience view on new BASIL-2 findings in headline peripheral session Data and discussion on revascularisation treatment strategies for patients with chronic limb-threatening ischaemia (CLTI) will take centre stage at the upcoming Charing Cross (CX) Symposium (25–27 April, London, UK), with first results from the BASIL-2 (Bypass versus angioplasty in severe ischaemia of the leg-2) randomised controlled trial set to be a highlight of this year’s programme.
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n keeping with CX style, audience participation will be world’ [UK] NHS management of severe limb ischaemia at the heart of the discussion in this headline session. due to infrapopliteal disease”. Attendees in London and remote participants will The original BASIL-1 trial, on which BASIL-2 have the opportunity to pose questions to the BASIL-2 is based, randomised 452 patients with severe limb investigators, who—along with an expert panel—will ischaemia, mainly due to femoropopliteal disease, to interrogate the evidence in a roundtable discussion to reach either an angioplasty first or a bypass surgery first strategy, consensus on this hotly debated topic. Popplewell and colleagues write. This study, published in In the peripheral space, revascularisation treatment The Lancet in 2005, found that, in patients presenting with strategies for patients with CLTI have been firmly in the severe limb ischaemia due to infrainguinal disease and who spotlight following the presentation of first results from are suitable for surgery and angioplasty, a bypass-surgeryBEST-CLI (Best endovascular versus best surgical therapy first and a balloon-angioplasty-first strategy are associated in patients with critical limb ischaemia) trial in November with “broadly similar outcomes in terms of amputation-free 2022. CX will provide a platform to move the conversation survival,” and in the short term, “surgery is more expensive forward and reach consensus on the topic, with first-tothan angioplasty”. podium results of the BASIL-2 randomised trial forming BASIL-2 officially began its recruitment phase in July the centrepiece of a peripheral randomised controlled trial 2014 with its first randomisation from the lead centre— consensus update, taking place on the first day of the Heart of England NHS Foundation Trust—and, according CX symposium. to the BASIL-2 trial webpage, a total of 41 clinical centres During the session, BASIL-2 chief investigator were open to the end of the trial; 31 in England, three in Andrew Bradbury (University of Birmingham, Scotland, two in Wales, three in Denmark, and Birmingham, UK) will deliver the first results two in Sweden. On the webpage it is noted that from the trial, which Matthew A Popplewell 39 of the 41 clinical centres have cumulatively (Heart of England Foundation Trust, Solihull, recruited 345 participants out of a revised UK) et al note their 2016 study protocol paper, sample size of 389 patients. published in Trials, will “compare, at the point The headline CX session on revascularisation of clinical equipoise, the clinical and coststrategies in CLTI also sees participation effectiveness of a ‘vein bypass first’ with a ‘best from the USA, with BEST-CLI investigators endovascular treatment first’ revascularisation Matthew Menard (Brigham and Women’s strategy for severe limb ischaemia due to Hospital, Boston, USA) and Alik Farber infrapopliteal (below-the-knee) disease”. (Boston Medical Center, Boston, USA) Sign up now The trial, the authors continue, “is designed to for CX 2023 be pragmatic and representative of the ‘realContinued on page 4
Surgical training:
Launch Pad
Change is needed page 25
Age is just a number: Individual patient data metaanalysis probes safety of CEA in the elderly A newly published meta-analysis of individual patient data has found that older patients with symptomatic carotid disease are likely to benefit as much from timely intervention as younger patients. Speaking to Vascular News in light of this key finding, senior author Dominic Howard (Oxford University Hospitals NHS Trust, Oxford, UK) stresses that “vascular surgeons must not turn down symptomatic patients just because of their age”. WRITING IN STROKE, YA YUAN Rachel Leung (University of Oxford, Oxford, UK), Howard and colleagues note that there is “uncertainty” around whether elderly patients with symptomatic carotid stenosis have higher rates of adverse events following carotid endarterectomy (CEA). “In trials, recurrent stroke risk on medical therapy alone increased with age, whereas operative stroke risk was not related,” they detail, adding, however, that few octogenarians were included in previous trials and that there has been no systematic analysis of all study types. For these reasons, the investigators aimed to evaluate the safety of CEA in symptomatic elderly patients, particularly in octogenarians. Leung, Howard et al state that they performed a systematic review and metaanalysis of all studies published between 1 Jan 1980 and 1 March 2022 reporting post-CEA risk of stroke, myocardial infarction (MI), and death in patients with symptomatic carotid stenosis. The authors write that they included observational studies and interventional arms of randomised trials if the outcome rates— or the raw data to calculate these—were provided, and that individual patient data from four prospective cohorts enabled multivariate analysis. The investigators included a total of 47 studies—representing 107,587 patients—in their meta-analysis. Within this cohort, the risk of perioperative stroke was 2.04% Continued on page 6