[Treatment of chronic limb-threatening ischemia (CLTI) based on BEST-CLI and BASIL-2]. / Therapie der chronischen extremitätenbedrohenden Ischämie.
Dtsch Med Wochenschr
; 149(17): 1002-1008, 2024 Aug.
Article
de De
| MEDLINE
| ID: mdl-39146746
ABSTRACT
The rate of vascular recanalizations in CLTI is increasing worldwide. Safety and efficacy of surgical versus endovascular treatment in CLTI patients was investigated in 2 prospective randomized trials with contrasting results. The BEST-CLI trial randomized 1830 patients with CLTI, the Bypass versus Angioplasty for Severe Ischaemia of the Leg (BASIL-2) trial included 345 patients with CLTI. Best-CLI evaluated outcome events as the primary endpoint, which includes major reinterventions in addition to major amputations and death. Only half of the CLTI patients received a crural intervention or surgery. There were no differences in major amputations or death. After a median follow-up (FU) of 2,7 years, the surgery group showed significantly better results compared to the endovascular group, due to fewer re-interventions. BASIL-2 used amputation-free survival as the primary outcome and only included patients with lower leg lesions. After a median FU of 40 months, endovascular therapy was found to be superior. The extremely high mortality rate was remarkable in both studies. The BEST-CLI study represents CLTI patients only to a limited degree, whereas the BASIL-2 study presents the treatment of CLTI patients with below-the-knee-lesions quite well. Both studies confirm that patients with CLTI should be treated in specialized centers that offer both crural surgery and endovascular therapy. Cardiovascular risk factor management must play a more important role in reducing the high mortality associated with CLTI.
Texte intégral:
1
Collection:
01-internacional
Base de données:
MEDLINE
Sujet principal:
Amputation chirurgicale
Limites:
Aged
/
Female
/
Humans
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Male
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Middle aged
Langue:
De
Journal:
Dtsch Med Wochenschr
Année:
2024
Type de document:
Article
Pays de publication:
Allemagne