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The BEST-CLI randomized trial compared surgical and endovascular revascularization strategies in patients with chronic limb-threatening ischaemia. The study was designed to provide modern comparative evidence in a field where both approaches are widely used and where patient anatomy and conduit availability strongly influence treatment choice. In patients with a suitable single-segment saphenous vein, surgical bypass provided better limb-related outcomes than an endovascular-first strategy. In the broader population, outcomes were more balanced when an adequate surgical conduit was not available. For surgeons, the important lesson is that there is no universal winner between open and endovascular revascularization. The patient's vascular anatomy, conduit quality, procedural risk, life expectancy, comorbidities and local expertise all matter. The trial supports a shared, anatomy-driven decision rather than a blanket “endovascular first” or “surgery first” rule. It also highlights the value of multidisciplinary vascular teams capable of offering both approaches. BEST-CLI is especially relevant to ASICON's vascular and endovascular training because it demonstrates how randomized evidence can help determine which technology or operation is most appropriate for a specific patient.
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The BEST-CLI randomized trial compared surgical and endovascular revascularization strategies in patients with chronic limb-threatening ischaemia. The study was designed to provide modern comparative evidence in a field where both approaches are widely used and where patient anatomy and conduit availability strongly influence treatment choice. In patients with a suitable single-segment saphenous vein, surgical bypass provided better limb-related outcomes than an endovascular-first strategy. In the broader population, outcomes were more balanced when an adequate surgical conduit was not available. For surgeons, the important lesson is that there is no universal winner between open and endovascular revascularization. The patient's vascular anatomy, conduit quality, procedural risk, life expectancy, comorbidities and local expertise all matter. The trial supports a shared, anatomy-driven decision rather than a blanket “endovascular first” or “surgery first” rule. It also highlights the value of multidisciplinary vascular teams capable of offering both approaches. BEST-CLI is especially relevant to ASICON's vascular and endovascular training because it demonstrates how randomized evidence can help determine which technology or operation is most appropriate for a specific patient.
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