In this issue: 02 G uest editorial Vascular surgeons: The ‘oncologists’ of surgery
15 D rug technology New VQI paclitaxel data shed light on challenging fempop anatomy
11 C omment & Analysis Bright future predicted for Journal of Vascular Surgery internship program
NOVEMBER 2022 Volume 18 Number 11
THE OFFICIAL NEWSPAPER OF THE
16 Presidential address Robert Rhee talks evolution during Eastern Vascular Society address www.vascularspecialistonline.com
First data from BESTCLI bring surgical bypass into the forefront of discussion for patients with high-quality great saphenous vein
SVS REVEALS RESEARCH PRIORITIES FOR NEXT DECADE
SPECIAL REPORT
By Urmila Kerslake, Jocelyn Hudson, Bryan Kay and Anthony Strzalek
T
he first results from the BEST-CLI randomized controlled trial (RCT) of 1,830 patients show that surgical bypass with adequate single-segment great saphenous vein (GSV) is a more effective revascularization strategy for patients with chronic limb-threatening ischemia (CLTI) who are deemed to be suitable for either an open or endovascular approach. Researchers also found that both strategies can be accomplished safely and are effective for treatments for CLTI. Further, the investigators urge that patients with CLTI who are candidates for limb salvage should undergo an evaluation of surgical risk and conduit availability. “Bypass surgery with adequate single-segment saphenous vein should be offered as a first-line treatment option for suitable candidates with CLTI as part of a fully informed shared decision-making. Level-one evidence from BEST-CLI does not support an
By Beth Bales
Alik Farber delivers long-anticipated data from the BEST-CLI trial, showing the difference between the open and endo arms in Cohort 1
endovascular-first approach to all patients with CLTI. In patients without a suitable single-segment saphenous vein, both surgical and endovascular strategies are effective in treating patients with CLTI, so we believe that there is a complementary role for both revascularization strategies in these patients,” they say, bringing the “quality of vein” back into the center of discussion on revascularization strategy. The co-principal investigators—Matthew Menard, MD, director of the vascular and endovascular fellowship program at Brigham and Women’s Hospital in Boston; Alik Farber, MD, chief of vascular and endovascular surgery at Boston Medical Center; and Kenneth Rosenfield, MD, section head of vascular medicine and intervention at Massachusetts General Hospital, also in Boston—note that this is the largest RCT comparing revascularization treatment strategies in patients with CLTI and will provide important information regarding the management of these patients. Farber presented the much-anticipated clinical results, and Menard the quality-of-life analysis, from BEST-CLI at the American Heart Association (AHA) Scientific Sessions (Nov. 5–7) in Chicago. The results were simultaneously published in the New England Journal of Medicine. BEST-CLI (Best endovascular versus best surgical therapy for patients with CLTI) randomized patients with CLTI and infrainguinal
See page 12–13
THE SOCIETY FOR VASCULAR Surgery (SVS) Research Council has updated its top-10 research priorities, originally published in 2011, with patient-centered outcomes and personalized vascular care at their core and a new emphasis on healthcare disparities. The priorities help the Society target research proposals for its own grants and awards, and provide external organizations with what SVS members regard as important goals, said Edith Tzeng, MD, and Matthew Corriere, MD, of the Research Council. The updated areas of research focus on aortic, carotid, lower extremity arterial (two priorities each) and venous disease, along with dialysis access, healthcare disparities and medical management of vascular disease (one priority each). The new priorities add disparities as well as vascular medicine/vascular health as areas of focus, highlighting a shift in emphasis over the past decade. “We can’t focus on everything,” said Corriere. “Part of our discussion was ‘what do we want to call attention to in the updates?’” The updated priorities “reflect our increasing awareness of the need to understand vascular disease pathogenesis and prevention in the context of a diverse
See page 18–19
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