Related Experiment Video
Updated: Jul 9, 2025
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Investigator attitudes on equipoise and practice patterns in the BEST-CLI trial
Alik Farber1, Jeffrey J Siracuse1, Kristina Giles2
1Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA.
Journal of Vascular Surgery
|December 6, 2023
Summary
Vascular specialists show diverse practice patterns for chronic limb-threatening ischemia (CLTI). While endovascular approaches are common, open surgery remains preferred for certain conditions, with similar equipoise observed over time.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Interventional Radiology
Background:
- Significant variability exists in practice patterns and equipoise for treating chronic limb-threatening ischemia (CLTI).
- The Best Endovascular vs Best Surgical Therapy in Patients with CLTI (BEST-CLI) trial aimed to address these variations.
Purpose of the Study:
- To assess treatment preferences of BEST-CLI investigators for open (OPEN) and endovascular (ENDO) revascularization strategies before and after the trial.
- To compare current practices with historical data from 2010.
Main Methods:
- An electronic survey was distributed to 1180 BEST-CLI investigators in 2022.
- Investigator preferences were evaluated across various clinical scenarios for OPEN and ENDO strategies.
- Responses were compared to a 2010 survey of prospective investigators.
Main Results:
- The 2022 survey showed a 20.2% response rate, primarily vascular surgeons (76.3%).
- The common practice distribution was 70% ENDO and 30% OPEN revascularization.
- While overall equipoise remained similar among vascular surgeons, preferences shifted slightly, with increased ENDO choice for minor tissue loss and OPEN surgery preferred more for popliteal occlusion.
Conclusions:
- Vascular specialists treating CLTI exhibit a wide range of practice patterns.
- BEST-CLI investigators possess experience in both advanced OPEN and ENDO techniques.
- Equipoise among vascular surgeons regarding CLTI treatment remained largely consistent over the decade of the BEST-CLI trial.
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