Abstract
Background
Severe limb ischaemia (SLI) is defined as the presence of rest pain and/or tissue loss secondary to lower extremity atherosclerotic peripheral arterial disease. The superficial femoral and popliteal arteries are the most commonly diseased vessels in such patients and are being increasingly treated using endovascular revascularisation techniques. However, it is currently unknown whether drug-eluting stents and drug-coated balloons confer additional clinical benefits over more established techniques using plain balloons and bare metal stents, or whether they represent a cost-effective use of NHS resources.
Methods
The BASIL-3 trial is a UK National Institute for Health Research, Health Technology Assessment Programme-funded, multicentre, randomised controlled trial (RCT) comparing the clinical and cost-effectiveness of plain balloon angioplasty with or without bail-out bare metal stenting, drug-coated balloon angioplasty with or without bail-out bare metal stenting, and primary stenting with drug-eluting stents for SLI secondary to femoro-popliteal disease. Patients with ‘multilevel’ disease may receive aorto-iliac and/or infrapopliteal treatments concurrently with their randomised femoro-popliteal intervention. The primary clinical outcome is amputation-free survival defined as the time to major (above the ankle) amputation of the index limb or death from any cause. The primary outcome for the economic analysis is cost per quality-adjusted life year. Secondary outcome measures include overall survival, major adverse limb events, major adverse cardiac events, relief of ischaemic pain, healing of tissue loss, and quality of life. The required sample size has been calculated at 861 participants (287 on each arm). These patients will be recruited over 3 years and followed-up for between 2 and 5 years.
Discussion
BASIL-3 is a pragmatic RCT designed to reflect current UK clinical practice. The results will inform decision-making regarding the appropriateness of funding the use of drug-coated balloons and drug-eluting stents, by the NHS, for the management of SLI due to femoro-popliteal disease.
Trial registration
ISRCTN Registry, identifier: ISRCTN14469736. Registered on 22 October 2015.
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Details
1 University of Birmingham, Birmingham Clinical Trials Unit, Institute of Applied Health Research, College of Medical and Dental Sciences, Public Health Building, Birmingham, UK (GRID:grid.6572.6) (ISNI:0000 0004 1936 7486)
2 University Department of Vascular Surgery, Heart of England NHS Foundation Trust, Netherwood House, Solihull Hospital, Solihull, UK (GRID:grid.416109.b) (ISNI:0000 0004 0399 7520)
3 University of Birmingham, Health Economics Unit, Institute of Applied Health Research, Public Health Building, Birmingham, UK (GRID:grid.6572.6) (ISNI:0000 0004 1936 7486)