Surgery or endovascular therapy for chronic limb-threatening ischemia.

Farber A, Menard MT, Conte MS, Kaufman JA, Powell RJ, Choudhry NK et al, for the BEST-CLI Investigators.

N Engl J Med 2022; 387: 2305-2316.

This international trial enrolled 1830 patients, and the endpoint was a composite of amputation, major reintervention or death. In the group with adequate saphenous vein, after a median of 2.7 years of follow-up, the endpoint was reached by 42.6 per cent of the surgery group compared to 57.4 per cent of the endovascular first group P<0.001). Outcomes were equivalent in those without an adequate vein.

Comment: Great study that confirms what many vascular surgeons have thought for a long time: endovascular treatment is great, but if you are fit enough and have vein for a bypass it will probably last you longer.