A vein bypass first versus a best endovascular treatment first revascularization strategy for patients with chronic limb-threatening ischaemia who require an infra-popliteal, with or without an additional more proximal infra-inguinal, revascularization procedure to restore limb perfusion: the BASIL-2 within-trial health economic analysis

Terlouw LG, van Dijk LJD, van Noord D, Bakker OJ, Bijdevaate DC, Erler NS et al, on behalf of the Dutch Mesenteric Ischemia Study Group.

Lancet Gastrohepatol 2024; 9: 299-309.

Ninety-four patients with chronic mesenteric ischaemia were included. Only one patient died. After 24 months, the patency of covered stents was better than bare metal stents: 81 versus 49 per cent, P<0.0001. Access site adverse events were more common in covered stent procedures.

Comment: This study does not address whether symptoms were improved alongside patency.

Mohamed AH, Howitt A, Rae S, Cai PL, Hitchman L, Wallace T et al.

Br J Surg 2024; 111: znae195.

Some 206 of the original 280 patients were available for analysis. Both procedures resulted in durable improvements in disease-specific quality of life (P<0.001). Clinical recurrence was lower after endothermal ablation: 37 versus 59 per cent, P=0.005.

Comment: Endothermal ablation has real long term advantages.

Goldenberg NA, Kittelson JM, Abshire TC, Bonaca M, Casella JF, Dale RA et al, for the Kids-DOTT Trial investigators and the ATLAS Group.
JAMA 2022; 327: 129-137.

Some 417 patients under 21 years of age were included. Rates of recurrent venous thromboembolism were similarly low after both treatments: 0.66 per cent after six weeks of versus 0.7 per cent after three months of anticoagulation.

Comment: Very low recurrence rates, but six weeks of anticoagulation seems reasonable.