Abstracts from the current literature By Ripal T. Gandhi, MD, FSIR, and Suvranu Ganguli, MD, FSIR


This column alerts SIR members to abstracts that may have an impact on their practice and how they converse with referring clinicians. If you would like to suggest abstracts you feel should be included, email us at gandhi@baptisthealth.net or suvranu.ganguli@bmc.org.


 The key takeaways accompanying each abstract were generated using human-assisted AI.


A vein bypass first versus a best endovascular treatment first revascularisation strategy for patients with chronic limb threatening ischaemia who required an infra-popliteal, with or without an additional more proximal infra-inguinal revascularisation procedure to restore limb perfusion (BASIL-2): An open-label, randomised, multicentre, phase 3 trial


Lancet. 2023 May 27;401(10390):1798–1809.


Bradbury AW, Moakes CA, Popplewell M, Meecham L, Bate GR, Kelly L, Chetter I, Diamantopolous A, Ganeshan A, Hall J, Hobbs S, Houlind K, Jarrett H, Lockyer S, Malmstedt J, Patel JV, Patel S, Rashid ST, Saratzis A, Slinn G, Scott DJA, Zayed H, Deeks JJ


Methods: Bypass versus Angioplasty for Severe Ischemia of the Leg (BASIL)-2 was an open-label, pragmatic, multicenter, phase 3, randomized trial done at 41 vascular surgery units in the United Kingdom (n=39), Sweden (n=1) and Denmark (n=1). Eligible patients were those who presented to hospital- based vascular surgery units with chronic limb-threatening ischemia due to atherosclerotic disease and who required an infrapopliteal, with or without an additional more proximal infrainguinal, revascularization procedure to restore limb perfusion. Participants were randomly assigned (1:1) to receive either vein bypass (vein bypass group) or best endovascular treatment (best endovascular treatment group) as their first revascularization procedure through a secure online randomization system. Participants were excluded if they had ischemic pain or tissue loss considered not to be primarily due to atherosclerotic peripheral artery disease. Most vein bypasses used the great saphenous vein and originated from the common or superficial femoral arteries. Most endovascular interventions comprised plain balloon angioplasty with selective use of plain or drug-eluting stents. Participants were followed up for a minimum of 2 years. Data were collected locally at participating centers. In England, Wales and Sweden, centralized databases were used to collect information on amputations and deaths. Data were analyzed centrally at the Birmingham Clinical Trials Unit. The primary outcome was amputation-free survival defined as time to first major (above the ankle) amputation or death from any cause measured in the intention-to-treat population. Safety was assessed by monitoring serious adverse events up to 30-days after first revascularization. The trial is registered with the ISRCTN registry, ISRCTN27728689.


Conclusion: In the BASIL-2 trial, a best endovascular treatment first revascularization strategy was associated with a better amputation-free survival, which was largely driven by fewer deaths in the best endovascular treatment group. These data suggest that more patients with chronic limb-threatening


ischemia who required an infrapopliteal, with or without an additional more proximal infrainguinal, revascularization procedure to restore limb perfusion should be considered for a best endovascular treatment first revascularization strategy.


Key takeaways: The objective of the BASIL-2 trial was to compare two treatment strategies for chronic limb-threatening ischemia caused by atherosclerotic disease in the leg. The two treatment strategies were vein bypass and best endovascular treatment (plain balloon angioplasty with selective use of stents).


The primary outcome of the study was amputation-free survival, defined as the time it took for participants to experience either a major amputation (above the ankle) or death from any cause. The study found that the best endovascular treatment strategy was associated with better amputation-free survival, largely driven by fewer deaths in the best endovascular treatment group.


Based on the study’s findings, the authors suggest that a best endovascular treatment first revascularization strategy should be considered for more patients with chronic limb-threatening ischemia who required infrapopliteal (below the knee) revascularization procedures to restore blood flow to the limb. This indicates that the endovascular approach may offer better outcomes in these patients compared to vein bypass as the first- line treatment option.


Prevalence and predictors of cardiogenic shock in intermediate-risk pulmonary embolism: Insights from the FLASH registry


JACC Cardiovasc Interv. 2023 Apr 24;16(8):958–972. doi: 10.1016/j. jcin.2023.02.004.


Bangalor S, Horowitz JM, Beam D, Jaber WA, Khandhar S, Toma C, Weinberg MD, Mina B


Background: Patients with acute pulmonary embolism (PE) and hypotension (high-risk PE) have high mortality. Cardiogenic shock can also occur in nonhypotensive or normotensive patients (intermediate-risk PE) but is less well characterized.


Objectives: The authors sought to evaluate the prevalence and predictors of normotensive shock in intermediate-risk PE.


Methods: Intermediate-risk PE patients in the FLASH (FlowTriever All-Comer Registry for Patient Safety and Hemodynamics) registry undergoing mechanical thrombectomy with the FlowTriever System (Inari Medical) were included. The prevalence of normotensive shock (systolic blood pressure ≥90 mm Hg but cardiac index ≤2.2 L/min/m2) was assessed. A composite shock score consisting of markers of right ventricular function and ischemia (elevated troponin, elevated B-type natriuretic peptide, moderately/severely


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