Improving treatment for Severe Limb Ischaemia

Severe Ischaemia of the Leg

Lead investigator: Andrew Bradbury

Introduction

Professor Andrew Bradbury is Sampson Gamgee Professor of Vascular Surgery in the Department of Cardiovascular Sciences.

Professor Bradbury led the HTA-funded Bypass Versus Angioplasty in Severe Ischaemia of the Leg (BASIL) trial, which was the first, and only, randomised controlled trial to investigate whether surgical bypass or keyhole treatment is best at relieving symptoms and preventing amputation or death in patients with Severe Limb Ischaemia (SLI).  

The outcomes of the study have been of worldwide interest, and the recommendations put forward by the team have been endorsed by a number of high profile clinical organisations. These findings are also now incorporated within a series of national and international guidelines on SLI.

Research objectives

SLI is a condition where atherosclerosis (hardening of the arteries) leads to a severe lack of blood supply to the leg, and is a common cause of pain, gangrene, amputation and death.  It is a major worldwide health and social care issue.  The number of patients who need treatment for SLI is likely to increase significantly as a result of ageing populations, tobacco use and the increasing prevalence of diabetes.

Failure to improve the blood supply to the leg (‘revascularisation’) in SLI can lead to amputation and death rates as high as 50% at 12 months. These risks can be dramatically reduced by timely intervention. The two principal treatment alternatives for SLI are bypass surgery and keyhole treatment.

Both revascularisation strategies have advantages and disadvantages, and for many years there has been fierce debate within vascular surgery as to which patient is best treated by which method.

Research output

SLI is a condition where atherosclerosis (hardening of the arteries) leads to a severe lack of blood supply to the leg, and is a common cause of pain, gangrene, amputation and death.  It is a major worldwide health and social care issue.  The number of patients who need treatment for SLI is likely to increase significantly as a result of ageing populations, tobacco use and the increasing prevalence of diabetes.

Failure to improve the blood supply to the leg (‘revascularisation’) in SLI can lead to amputation and death rates as high as 50% at 12 months. These risks can be dramatically reduced by timely intervention. The two principal treatment alternatives for SLI are bypass surgery and keyhole treatment.

Both revascularisation strategies have advantages and disadvantages, and for many years there has been fierce debate within vascular surgery as to which patient is best treated by which method.

Research impact

The BASIL trial led to a number of recommendations, many of which have been actively embraced by NICE as part of their Peripheral Arterial Disease (PAD) Clinical Guidelines.

The impact of these findings and their clinical uptake is not limited to the UK. Following publication of the trial outcomes Professor Bradbury has been invited to present the BASIL data in Europe, the Middle and Far East, North and South America and Australia. The novel insights and recommendations emanating from BASIL were consequently adopted into and highlighted in a number of key international guidelines which are now guiding clinical practice in this area.

As a result of this work, the World Federation of Vascular Societies, (WFVS) Society for Vascular Surgery (SVS) and European Society for Vascular Surgery (ESVS) have agreed on the need for clear standards for peripheral arterial care, and are working together to develop standard guidelines.

These societies represent almost all vascular surgical societies in the countries in the world, and Professor Bradbury will now lead the discussions and collaborations across not only Europe but also Asia, Australasia and Southern Africa that take this important area of patient care forward.

Learn more

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