The BASIL trial compared bypass surgery versus balloon angioplasty for severe lower limb ischaemia. What was the key finding regarding patient selection?

• A Angioplasty was superior in all patients for amputation-free survival at 2 years
• B Bypass surgery had unacceptably high 30-day mortality and should be abandoned
• C Both strategies had identical outcomes; choice depends only on anatomical suitability
• D Surgery-first strategy showed improved amputation-free survival in patients surviving > 2 years ✓

Explanation

The BASIL (Bypass versus Angioplasty in Severe Ischaemia of the Leg) trial showed that at 2 years, there was no significant difference in amputation-free survival between the two strategies. However, in patients who survived beyond 2 years, the surgery-first group had significantly better amputation-free survival and overall survival, as well as better quality of life — suggesting bypass surgery provides a more durable result for patients with longer life expectancy. For patients with limited life expectancy (< 2 years due to comorbidities), angioplasty-first is preferred due to lower procedural morbidity and resource use.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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