Related Experiment Video

Updated: Apr 15, 2026

Assessing Therapeutic Angiogenesis in a Murine Model of Hindlimb Ischemia
07:48

Assessing Therapeutic Angiogenesis in a Murine Model of Hindlimb Ischemia

Published on: June 8, 2019

9.4K

The BEST-CLI trial: a multidisciplinary effort to assess whether surgical or endovascular therapy is better for

Matthew T Menard1, Alik Farber2

  • 1Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, Boston, MA 02115.

Seminars in Vascular Surgery
|March 28, 2015
PubMed

Insights

Critical limb ischemia (CLI), a severe peripheral arterial disease, poses a limb loss risk. The BEST-CLI trial compares best endovascular versus surgical therapy to guide treatment decisions for CLI patients.

Area of Science:

  • Vascular Surgery
  • Interventional Cardiology
  • Peripheral Arterial Disease

Background:

  • Critical limb ischemia (CLI) is the most severe form of peripheral arterial disease, carrying a significant risk of limb loss.
  • Current treatments involve limb revascularization via surgery or endovascular intervention, with ongoing debate regarding optimal first-line therapy and success rates.
  • A lack of comparative effectiveness data hinders evidence-based treatment guidance for CLI.

Purpose of the Study:

  • To compare the effectiveness of the best available endovascular therapy versus the best available open surgical therapy in patients with CLI who are eligible for both procedures.
  • To provide urgently needed clinical guidance for the management of CLI through a pragmatic, multidisciplinary approach.
  • To evaluate novel primary endpoints and cost-effectiveness alongside quality-of-life outcomes.

Main Methods:

  • The Best Endovascular Versus Best Surgical Therapy in Patients With CLI (BEST-CLI) trial is a pragmatic, multicenter, open-label, randomized trial.
  • It directly compares best endovascular therapy against best open surgical treatment in eligible CLI patients.
  • The trial incorporates a multidisciplinary structure and novel methods for assessing cost-effectiveness and quality of life.

Main Results:

  • The BEST-CLI trial is designed to generate comparative effectiveness data for CLI treatment strategies.
  • It aims to resolve disagreements on the superiority of endovascular versus surgical interventions for CLI.
  • Results will inform clinical practice by comparing limb amputation rates, repeat interventions, and mortality between the two treatment groups.

Conclusions:

  • The BEST-CLI trial will provide crucial evidence to guide the selection of endovascular or surgical revascularization for critical limb ischemia.
  • Findings are expected to clarify the comparative effectiveness and outcomes of these major treatment modalities.
  • The study's multidisciplinary design and comprehensive endpoints will offer valuable insights into optimizing CLI management.

More Related Videos

Predicting Amputation using Local Circulating Mononuclear Progenitor Cells in Angioplasty-treated Patients with Critical Limb Ischemia07:25

Predicting Amputation using Local Circulating Mononuclear Progenitor Cells in Angioplasty-treated Patients with Critical Limb Ischemia

Published on: September 22, 2020

3.9K
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke09:21

Optimized Management of Endovascular Treatment for Acute Ischemic Stroke

Published on: January 18, 2018

12.8K

Related Concept Videos

Peripheral Artery Disease III: Interprofessional Care01:27

Peripheral Artery Disease III: Interprofessional Care

Peripheral Artery Disease (PAD) is characterized by narrowed arteries that diminish blood flow to the extremities. Effective management of PAD requires an interprofessional approach involving various healthcare professionals. The critical aspects of interprofessional care for PAD patients focus on risk factor modification, drug therapy, exercise therapy, nutrition therapy, critical limb ischemia care, and interventional radiology and surgical procedures.The primary treatment goal for PAD...
623
Peripheral Artery Disease V: Postoperative Nursing Management01:23

Peripheral Artery Disease V: Postoperative Nursing Management

During the postoperative period, it is crucial to focus on maintaining circulation, identifying and managing potential complications, and planning for discharge.Nursing AssessmentVital signs monitoring: Regularly monitor vital signs, including blood pressure, heart rate, respiratory rate, and temperature, to detect early signs of complications such as bleeding and infection.Circulation assessment: Monitor pulses, perform Doppler assessments, and check capillary refill, color, temperature, and...
597
Varicose Veins II: Diagnostic Studies and Interprofessional Care01:26

Varicose Veins II: Diagnostic Studies and Interprofessional Care

Varicose veins, or varicosities, develop when the valves in the veins, which control blood flow, weaken or damage. It causes blood to pool and the veins to enlarge. Understanding the clinical manifestations, diagnostic approaches, and management options for varicose veins is crucial for effective treatment and relief.Clinical manifestationsClinical manifestations of varicose veins include a heavy, achy feeling or pain after prolonged standing or sitting. This discomfort can often be relieved by...
298
Peripheral Artery Disease IV: Nursing Management01:26

Peripheral Artery Disease IV: Nursing Management

 The nursing management of a patient with peripheral artery disease (PAD) begins with a thorough assessment of the patient’s health history and clinical manifestations.AssessmentHealth History: Evaluate the patient’s history of hypertension, hyperlipidemia, family history of cardiovascular issues, and lifestyle factors such as dietary patterns, smoking, and physical activity.Physical Examination:Assess the affected extremity for decreased or absent peripheral pulses,...
642
Venous Thrombosis III: Interprofessional Care01:29

Venous Thrombosis III: Interprofessional Care

Venous thrombosis requires effective prevention and treatment strategies to improve patient outcomes and reduce potential complications.Prevention StrategiesHealthcare providers must prioritize preventing venous thromboembolism (VTE) for all adult patients upon admission. Interventions depend on bleeding and thrombosis risk, medical history, current medications, diagnoses, planned procedures, and patient preferences. Patients on bed rest should change positions every two hours and, if not...
471
Peripheral Arterial Disease II: Clinical Manifestations and Diagnostic Evaluation01:21

Peripheral Arterial Disease II: Clinical Manifestations and Diagnostic Evaluation

Clinical manifestationsPeripheral Arterial Disease (PAD) manifests through a range of symptoms, from the characteristic intermittent claudication to atypical presentations and severe complications in advanced stages. Intermittent claudication, a hallmark symptom of PAD, presents as exercise-induced muscle pain that typically resolves within minutes of rest. This pain is reproducible and stems from inadequate blood flow, leading to the accumulation of lactic acid produced during anaerobic...
704