A 65-year-old man with diabetes and coronary artery disease presents with a non-healing ulcer over the right heel for 3 months. Ankle-brachial index is 0.4. Angiography shows multilevel disease with significant infrapopliteal disease and a 7 cm occlusion of the anterior tibial artery. He has a suitable single-segment great saphenous vein. According to the BASIL trial findings, what is the recommended first-line revascularization strategy?
- A Endovascular balloon angioplasty of the anterior tibial artery
- B Primary below-knee amputation
- C Surgical bypass using autologous vein to the dorsalis pedis artery ✓
- D Hybrid procedure with femoral endarterectomy and tibial angioplasty
Correct answer: C. Surgical bypass using autologous vein to the dorsalis pedis artery
Explanation
The BASIL trial (2005) showed that for severe limb ischemia due to infrainguinal disease, patients predicted to survive more than 2 years had better outcomes with surgical bypass using autogenous vein as first strategy. Those with suitable veins should undergo bypass. Endovascular-first approach had higher reintervention rates and eventual crossover to surgery. The 2-year survival cutoff is key to decision-making. Primary amputation is reserved when revascularization is not feasible.
Reference: Rutherford's Vascular Surgery and Endovascular Therapy, 9th ed.
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Written and medically reviewed by the StethoPrep medical team.