BEST CLI: Best Endovascular vs.

Best Surgical Therapy in Patients

With Critical Limb Ischemia
Purpose: To compare the effectiveness of best
available surgical treatment with best available HR
Primary Endpoints Surgery Endovasc p-value
(95%CI)
endovascular treatment in adults with critical limb
threatening ischemia (CLTI). SSGSV available (n=709) (n=711)
Trial Design: Randomized, prospective,
MALE or all cause death 302 408 0.68 <0.001
interventional, parallel assignment, open label, (42.6%) (57.4%) (0.59, 0.79)
multicenter (150), N= 1434.
Primary Endpoints: Time to major adverse limb event Above-ankle amputation 74 106 0.73 0.04
(MALE) or death, whichever occurs first in subjects of the index limb (10.4%) (14.9%) (0.54, 0.98)
with Single-Segment Great Saphenous Vein (SSGSV)
available; time to major adverse limb event or death, SSGSV not available (n=194) N=199)
whichever occurs first in subjects without available
SSGSV. MALE or all cause death 83 95 0.79 0.12
(42.8%) (47.7%) (0.58, 1.06)
Secondary Endpoints: Time to re-intervention of the
index leg, amputation of the index leg, or death, Above-ankle amputation 29 28 1.10 0.72
whichever occurs first in subjects with or without of the index limb (14.9%) (14.1%) (0.65, 1.87)
available SSGSV.
Results: Bypass surgery with adequate saphenous vein should be offered
Key Takeaway: BEST-CLI does not support an as a first line treatment option for suitable candidates with CLTI.
“endovascular-first” approach to all patients with CLTI.
Presented by: Alik Farber, MD Boston Medical Ctr, Boston, MA, USA.
Scientific Sessions 2022. © 2022. American Heart Association. All rights reserved.
Results reflect the data available at the time of presentation.

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