Bypass versus angioplasty in severe ischaemia of the leg (BASIL): Multicentre, randomised, controlled trial

Abstract

Randomized clinical trial comparing multiple stab incision phlebectomy and transilluminated powered phlebectomy for varicose veinsChetter IC, Mylankal KJ, Hughes H, et al. Br J Surg 2006;93:169-74. Conclusion:Transilluminated power phlebectomy (TIPP) compared with multiple stab incision phlebectomy (MSIP) results in fewer surgical incisions but has reduced early postoperative quality of life, with more extensive bruising and more prolongation of postoperative pain.Summary: This was a randomized clinical trial at a university teaching hospital in Australia. Patients who were to undergo surgery for varicose veins were randomized to receive either TIPP or MSIP for treatment of the varicosities. For both groups, analysis consisted of operative times, number of incisions, and postoperative outcome. A quality-of-life analysis was conducted at 1 and 6 weeks after surgery using disease-specific (Aberdeen varicose vein questionnaire) and generic (Short Form 36 and EuroQual 5D) measures as well as the domain-specific Burford Pain Scale. The MSIP arm of the trial had 33 patients, and the TIPP arm had 29 patients. All patients had complicated or symptomatic varicose veins. In the MSIP group, 29 of the 33 patients were CEAP class II, and 27 of 29 patients in the TIPP group were CEAP class II.Mean duration of surgery was 48 minutes (range, 41 to 63 minutes) in the MSIP patients and 50 minutes (range, 40 to 60 minutes) in the TIPP group (P ϭ .717). A significantly lower number of phlebectomy incisions were used in the TIPP group (mean, 5; range, 3 to 7), than the MISP group (mean, 20; range, 11 to 25) (P Ͻ .001). At 1 and 6 weeks, skin bruising was significantly higher in the TIPP group (P Ͻ .01), and the Burford Pain Scale at 6 weeks was also significantly higher in the TIPP group (P ϭ .019). At 1 week after surgery, both groups had significant deterioration on the qualityof-life outcomes domains of physical function, role play, and social function of the SF36. The magnitude of deterioration was greater after TIPP. At 6 weeks, patients who had TIPP had no significant change in any SF36 quality-of-life domain compared with pretreatment values. Patients treated with MSIP at 6 weeks showed significant improvements in role play and in physical and bodily pain.Comment: In this randomized trial of transilluminated power phlebectomy vs standard multiple stab incisions for varicose vein treatment, the only advantage of the transilluminated power phlebectomy was a decreased number of incisions. Surprisingly, there was no difference in operative time. If patient recovery is the issue, it therefore appears that standard multiple incisions provide a better outcome. If the patient is interested in fewer incisions for cosmetic concerns, transilluminated power phlebectomy will provide this but at the expense of a more prolonged recovery from the initial procedure.

High prevalence of ischaemia, infection and serious comorbidity in patients with diabetic foot disease in Europe. Baseline results from the Eurodiale study

“…Studies on the treatment of PAD in diabetic foot disease are also scarce, and many questions remain to be answered. It is unclear at what degree of peripheral ischaemia intervention is cost-effective and which procedure-bypass or endovascular intervention-should be performed [29,30]. Treatment of infection in patients with PAD is another topic that has gained little attention.…”

The “Safari” Technique to Perform Difficult Subintimal Infragenicular Vessels

“…In the short term, however, surgery is associated with a higher rate of morbidity [5]. This is because of the frequent presence of comorbidities at the time of intervention, occlusions extending below the knee, and limb tissue loss [1,15].…”

“…Percutaneous angioplasty, because of the progress of the intraluminal and the extraluminal techniques and the availability of new materials, has demonstrated great efficacy in the treatment of CLI in terms of success rate, clinical outcome, and procedure-related complications [4,5,16].…”

“…The percutaneous endovascular recanalization approach, consisting of the intraluminal or the subintimal technique, represents a valid alternative to the surgical bypass in patients at risk of limb loss and not suitable for surgery [3][4][5].…”

Safety of a non-viral plasmid-encoding dual isoforms of hepatocyte growth factor in critical limb ischemia patients: a phase I study

“…4,5 As there are currently few effective pharmacological therapies available for CLI, treatment consists primarily of revascularization or lower extremity amputation. 4,6 Therapeutic angiogenesis, either as recombinant protein, gene transfer or stem cell therapy, delivered to the ischemic muscle, has shown promising results and provides hope for CLI patients who are unsuitable candidates for revascularization. 7,8 Recent randomized controlled trials of vascular endothelial growth factor (VEGF) and fibroblast growth factors (FGF) have demonstrated excellent safety and significant clinical improvement including beneficial hemodynamic effects and a reduction in death and major amputation.…”