Relevance of BEST-CLI trial endpoints in a tertiary care limb preservation program

In a recent study conducted by a team from the University of California, San Francisco (UCSF), including Iris H. Liu, MD, Rym El Khoury, MD, Jade S. Hiramoto, MD MAS, Warren J. Gasper, MD, Peter A. Schneider, MD, Shant M. Vartanian, MD, and Michael S. Conte, MD, the relevance of the BEST-CLI trial endpoints was evaluated within a tertiary care limb preservation program. This single-center retrospective cohort study analyzed outcomes among 469 patients undergoing infrainguinal revascularization for chronic limb-threatening ischemia (CLTI), focusing on major adverse limb events (MALE) and survival rates.

The key findings of the study revealed that 51% of the patients experienced MALE or death, with autogenous vein bypass (AVB) showing superior MALE-free survival compared to other revascularization approaches. The study highlighted the significant impact of baseline comorbidities, limb severity, anatomic complexity, and the index revascularization approach on the outcomes. Notably, AVB was associated with the most durable limb salvage, especially in anatomically complex cases. The study also observed that the nature and timing of MALE differed from those reported in the BEST-CLI trial, with a higher incidence of major amputation following endoluminal (ENDO) or non-autogenous bypass procedures.

This research underscores the importance of selecting the appropriate revascularization strategy based on patient-specific factors and disease complexity. The findings suggest that AVB provides the greatest benefit in terms of MALE-free survival and should be considered, particularly for patients with complex anatomical challenges. The study’s insights into the real-world application of BEST-CLI trial endpoints contribute valuable knowledge to the field of limb preservation and vascular surgery, supporting the ongoing efforts to improve patient outcomes in CLTI management.

The UCSF team’s work, presented at the 2023 Western Vascular Society Annual Meeting, offers a critical examination of the BEST-CLI trial’s applicability in a tertiary care setting, providing a foundation for future research and clinical practice improvements in limb preservation strategies.

Citations:
[1] https://pubmed.ncbi.nlm.nih.gov/38401777/