Publications by authors named "AW Bradbury"
Article Synopsis
- The study investigates the effectiveness and cost-efficiency of two surgical approaches (vein bypass-first vs. best endovascular treatment-first) for treating chronic limb-threatening ischemia, which can lead to pain and tissue loss.
- Conducted in 40 medical centers across the UK, Sweden, and Denmark, the trial involved patients requiring revascularization due to atherosclerotic peripheral arterial disease.
- Key outcomes measured included amputation-free survival, overall survival rates, major amputations, quality of life, and costs associated with hospital treatments over a follow-up period of at least 2 years.
Article Synopsis
- The BASIL-2 trial compared outcomes between two revascularisation strategies for patients with chronic limb threatening ischaemia, finding that those who underwent vein bypass (VB) had a higher mortality rate than those who received best endovascular treatment (BET) over a median follow-up of 40 months.
- A panel of experts determined the primary causes of death for 151 out of 168 deceased participants, establishing that 35% of deaths in the VB group were likely cardiac compared to 21% in the BET group.
- The study revealed that participants in both groups had a notable history of heart issues (such as myocardial infarction and previous procedures), but no significant variations in treatment effects on cause of death were observed among patients
Objective: The Bypass versus Angioplasty in Severe Ischaemia of the Leg-2 (BASIL-2) randomised controlled trial has shown that, for patients with chronic limb threatening ischaemia (CLTI) who require an infrapopliteal (IP) revascularisation a vein bypass (VB) first revascularisation strategy led to a 35% increased risk of major amputation or death when compared with a best endovascular treatment (BET) first revascularisation strategy. The study aims are to place the BASIL-2 trial within the context of the CLTI patient population as a whole and to investigate the generalisability of the BASIL-2 outcome data.
Methods: This was an observational, single centre prospective cohort study.
A Systematic Review Network Meta-Analysis and Meta-Regression on Surgical and Endovenous Interventions for the Treatment of Lower Limb Venous Ulcer Disease.
J Endovasc Ther
August 2023
Background: Venous leg ulcer (VLU) disease constitutes the most severe form of chronic venous insufficiency. We performed a network meta-analysis and meta-regression to investigate the efficacy and safety of the various available interventions in the treatment of VLU.
Methods: We conducted a systematic research corresponding to the instructions by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement for studies reporting on surgical or endovenous interventions for the treatment of VLU.
Background: Chronic limb-threatening ischaemia is the severest manifestation of peripheral arterial disease and presents with ischaemic pain at rest or tissue loss (ulceration, gangrene, or both), or both. We compared the effectiveness of a vein bypass first with a best endovascular treatment first revascularisation strategy in terms of preventing major amputation and death in patients with chronic limb threatening ischaemia who required an infra-popliteal, with or without an additional more proximal infra-inguinal, revascularisation procedure to restore limb perfusion.
Methods: Bypass versus Angioplasty for Severe Ischaemia of the Leg (BASIL)-2 was an open-label, pragmatic, multicentre, phase 3, randomised trial done at 41 vascular surgery units in the UK (n=39), Sweden (n=1), and Denmark (n=1).
The diagnosis of peripheral arterial disease (PAD) is not always evident as symptoms and signs may show great variation. As all grades of PAD are linked to both an increased risk for cardiovascular complications and adverse limb events, awareness of the condition and knowledge about diagnostic measures, prevention and treatment is crucial. This article presents in a condensed form information on PAD and its management.
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- Landmark studies since the early 2000s identified a gap between evidence-based findings and their implementation in clinical practice, prompting this study to evaluate six surgical trials for actionable outcomes and their influence on practice.
- The study employed a mixed methods approach, starting with quantitative analysis of surgical procedure trends in England, followed by qualitative interviews with 25 healthcare professionals to interpret the quantitative data.
- Findings showed practice changes aligned with three trials, although one trial's implementation took a decade, while others either predated or adapted with the evolving evidence, highlighting varying timelines in integrating research into practice.
Background: The Global Limb Anatomic Staging System (GLASS) is a new method of quantifying the anatomic severity of infrainguinal disease in patients with chronic limb-threatening ischemia. However, because GLASS has undergone limited validation, its value as an aid to shared decision-making regarding the choice of revascularization strategy remains incompletely defined. Here we report the relationship between GLASS and outcomes in a contemporary series comprising all 309 patients who underwent an attempt at femoropopliteal and/or infrapopiteal endovascular therapy for chronic limb-threatening ischemia in our unit between 2009 and 2014.
View Article and Find Full Text PDFBackground: Ultrasound guided foam sclerotherapy (UGFS) is a flexible and highly utilised tool in the treatment of varicose veins (VVs), both as a primary treatment and as an adjunct to other treatments. Concern remains regarding the risk of neurological adverse events (AEs) such as migraine, visual disturbance and serious adverse events (SAEs) such as cerebrovascular accident that have been reported after UGFS treatments.
Aim: To determine the incidence of neurological AEs and SAEs after UGFS.
Objective: Chronic limb-threatening ischemia (CLTI) is a growing global problem due to the widespread use of tobacco and increasing prevalence of diabetes. Although the financial consequences are considerable, few studies have compared the relative cost-effectiveness of different CLTI management strategies. The Bypass vs Angioplasty in Severe Ischaemia of the Leg (BASIL)-2 trial is randomizing patients with CLTI to primary infrapopliteal (IP) vein bypass surgery (BS) or best endovascular treatment (BET) and includes a comprehensive within-trial cost-utility analysis.
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- - A study compared patient outcomes for chronic limb-threatening ischemia between two groups: one treated with femoropopliteal plain balloon angioplasty (FP-PBA) and selective bare metal stenting (CS, 2009-2014) and another group from the Bypass vs Angioplasty in Severe Ischaemia of the Leg trial (B1, 1999-2004).
- - Results showed CS patients were older and had more hospital admissions, with some undergoing more extensive endovascular procedures, while BMS were used significantly more in the CS group.
- - Critically, both amputation-free survival and overall survival rates were significantly worse for the CS group compared to B1, despite no differences in
Introduction: Despite the BASIL-1 trial concluding that bypass surgery (BS) was superior to plain balloon angioplasty (PBA) in terms of longer-term amputation free (AFS) and overall survival (OS), CLTI patients are increasingly offered an endovascular-first revascularization strategy. This study investigates whether the results of BASIL-1 are still relevant to current practice by comparing femoro-popliteal (FP) BS with PBA in a series of CLTI patients treated in our unit 10 years after BASIL-1 (1999-2004).
Methods: We retrospectively analyzed prospectively gathered hospital data pertaining to 279 patients undergoing primary FP BS or PBA for CLTI in the period 2009 to 2014.
Article Synopsis
- A subgroup analysis from the BASIL-1 trial indicates that patients with chronic limb threatening ischemia (CLTI) and infra-popliteal disease have better clinical outcomes with vein bypass surgery (BS) compared to balloon angioplasty (PBA).
- This study analyzed data from 137 CLTI patients who underwent either BS or PBA, focusing on metrics like hospitalization length, survival rates, and complication rates over a 3-year follow-up period.
- Results revealed that although BS patients experienced more complications shortly after surgery, they had significantly better long-term outcomes in amputation-free survival and overall survival, supporting the idea that BS is preferable for those eligible for revascularization.
Objective: The Global Vascular Guideline on chronic limb threatening ischaemia (CLTI) has introduced the Global Limb Anatomic Staging System (GLASS) as a new angiographic scoring system. However, the relationship between GLASS and outcomes following revascularisation has not previously been studied.
Methods: Using pre-intervention angiograms the relationship between GLASS and immediate technical failure (ITF), amputation free survival (AFS), limb salvage (LS), overall survival (OS), and freedom from major adverse limb events (FF-MALE) was examined in 377 patients undergoing endovascular therapy (EVT, n = 213) or bypass surgery (BS, n = 164) in the Bypass versus Angioplasty in Severe Ischaemia of the Leg (BASIL)-1 trial (randomised 1999-2004).
Article Synopsis
- This study compared patient outcomes from two different time periods; patients in the BASIL-1 trial (1999-2004) and those from a contemporary series (CS, 2009-2013) who underwent infrapopliteal plain balloon angioplasty (PBA) due to chronic limb-threatening ischemia.
- Researchers analyzed data on factors like amputation-free survival, overall survival, and hospital stay length, finding that while technical success rates improved over the years, overall survival outcomes did not significantly change.
- The study concluded that even though immediate success rates of the procedure increased, survival rates and major amputation rates remained similar between the two cohorts, with contemporary patients experiencing shorter hospital
Article Synopsis
- The study investigates outcomes of revascularisation for chronic limb threatening ischaemia (CLTI) in men versus women using data from the BASIL-1 trial, revealing mixed results in past cohort reports.
- It found that while women were older and had fewer risk factors at randomisation, they experienced significantly better long-term outcomes compared to men, including amputation-free survival, overall survival, and freedom from major adverse limb events after three years.
- The findings suggest that sex plays a crucial role in the effectiveness of revascularisation treatments and should be considered in developing treatment strategies for CLTI.