Key result
Surgical bypass improves toe pressure by ~11 mmHg over endovascular therapy in single-segment GSV patients.
Why the study?
To assess baseline haemodynamic parameters in BEST-CLI trial patients and analyse changes following revascularisation.
Does surgical bypass compared to endovascular revascularisation improve haemodynamic parameters at 30 days in patients with CLTI?
RCT
Does surgical bypass compared to endovascular revascularisation improve haemodynamic parameters at 30 days in patients with CLTI?
Absolute Event Rate: 92.4% vs 90.1%
p-value: p=.33
Both surgical and endovascular revascularisation significantly improve haemodynamic values at 30 days in CLTI patients, with surgical bypass yielding a greater increase in toe pressure among those with a suitable saphenous vein.
Bypass associated with greater toe pressure rise vs endovascular in suitable vein patients; leaves open impact on limb outcomes in CLTI.
OBJECTIVE: To assess the baseline haemodynamic parameters in Best Endovascular Therapy versus Best Surgical Therapy in Patients with CLTI (BEST-CLI) trial patients and to analyse the change after revascularisation (ClinicalTrials.gov identifier: NCT02060630). METHODS: Baseline and 30 day post-operative assessment parameters included ankle brachial index (ABI), toe pressure (TP), and toe brachial index. Statistical analyses were performed according to the actual treatment received and carried out separately in each cohort. RESULTS: Cohort 1 included patients who had a single segment of great saphenous vein available. At baseline, median ABI was 0.51 (interquartile range [IQR] 0.38, 0.68) and median TP was 33 mmHg (IQR 28.5, 48 mmHg), with no statistically significant differences between the surgical and endovascular groups. The median ABI increase was 0.44 (IQR 0.25, 0.60) in the bypass group and 0.44 (IQR 0.25, 0.61) in the endovascular group (p = .55). The median TP increase in the surgical group was 40 mmHg (IQR 13, 60 mmHg), compared with 29 mmHg (IQR 9, 54 mmHg) in the endovascular group (p = .032). An ABI increase of > 0.30 and or a TP increase of > 30 mmHg was noted in 92.4% and 90.1% of the patients in the surgical and endovascular groups, respectively (p = .33). Cohort 2 included patients who needed an alternative bypass conduit. The median ABI increase in the surgical and endovascular groups was 0.40 and 0.52 (p = .50), respectively. The median TP increase in the surgical group was 36 mmHg (IQR 7, 65 mmHg), compared with 47 mmHg (IQR 22, 65 mmHg) in the endovascular group (p = .27). An ABI increase of > 0.30 and or a TP increase of > 30 mmHg was noted in 91.0% and 90.7% of the patients in the surgical and endovascular groups, respectively (p = .94). CONCLUSION: In patients for whom a comparison was available, > 90% had statistically significantly improved haemodynamic values 30 days after revascularisation. A greater increase in TP was noted with surgical bypass than with endovascular revascularisation among patients who had a single segment great saphenous vein available.
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Venermo et al. (2025) conducted an RCT in Chronic limb-threatening ischemia (CLTI). Surgical bypass vs. Endovascular revascularisation was evaluated on ABI increase of > 0.30 and or a TP increase of > 30 mmHg at 30 days (Cohort 1) (p=.33). Surgical bypass resulted in a greater median increase in toe pressure compared to endovascular therapy among patients with a single segment great saphenous vein (40 vs 29 mmHg; p=0.032).
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