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Best Endovascular vs. Best Surgical Therapy in Patients With Critical Limb Ischemia

Official Title:

Best Endovascular Versus Best Surgical Therapy in Patients With Critical Limb Ischemia

Basic Trial Information

Phase Type Age Sponsor Protocol IDs Status
N/A Interventional 18 Years and older New England Research Institutes BEST-CLI Trial
Enrolling patients

Study Design:

Principal Investigator

Professor of Surgery
Division of Vascular and Endovascular Surgery
Associate Director,
Vascular Surgery Integrated Residency Program

Clinical Research Coordinator

Zuckerberg San Francisco General
(415) 353-4379 Phone
(415) 353-4370 Fax
UCSF Medical Center at Parnassus
415.353.4379 Phone
415.353.4370 Fax

Trial Summary

This study will compare the effectiveness of best available surgical treatment with best available endovascular treatment in adults with critical limb ischemia (CLI) who are eligible for both treatment options.


Inclusion Criteria:

     1. Male or female, age 18 years or older.
     2. Infrainguinal PAOD (occlusive disease of the arteries below the inguinal ligament).
     3. CLI, defined as arterial insufficiency with gangrene, non-healing ischemic ulcer, or
         rest pain consistent with Rutherford categories 4-6.
     4. Candidate for both endovascular and open infrainguinal revascularization as judged by
         the treating investigators
     5. Adequate aortoiliac inflow.
     6. Adequate popliteal, tibial or pedal revascularization target defined as an
         infrainguinal arterial segment distal to the area of stenosis/occlusion which can
         support a distal anastomosis of a surgical bypass.
     7. Willingness to comply with protocol, attend follow-up appointments, complete all study
         assessments, and provide written informed consent.
Exclusion Criteria:

     1. Presence of a popliteal aneurysm (>2 cm) in the index limb.
     2. Life expectancy of less than 2 years due to reasons other than PAOD.
     3. Excessive risk for surgical bypass (as determined by the operating surgeon and the CLI
     4. Planned above ankle amputation on ipsilateral limb within 4 weeks of index procedure.
     5. Active vasculitis, Buerger's disease, or acute limb-threatening ischemia
     6. Any prior index limb infrainguinal stenting or stent grafting associated with
         significant restenosis within 1 cm of stent or stent-graft, unless the
         occlusion/restenosis site is outside the intended treatment zone (i.e.,. a tibial
         vessel that is not currently intended to be revascularized as a part of the treatment
         for CLI).
     7. Any of the following procedures performed on the index limb within 3 months prior to
       Infrainguinal balloon angioplasty, atherectomy, stent, or stentgraft;
       Infrainguinal bypass with either venous or prosthetic conduit
     8. Open surgical inflow procedure (aortofemoral, axillofemoral, iliofemoral,
         thoracofemoral or femorofemoral bypass) within 6 weeks prior to enrollment
     9. Current chemotherapy or radiation therapy.
     10. Absolute contraindication to iodinated contrast due to prior near-fatal anaphylactoid
         reaction (laryngospasm, bronchospasm, cardiorespiratory collapse, or equivalent) which
         would preclude patient participation in angiographic procedures.
     11. Pregnancy or lactation.
     12. Administration of an investigational drug for PAD within 30 days of randomization.
     13. Participation in a clinical trial (except observational studies) within the previous
         30 days.
     14. Prior enrollment or randomization into BEST-CLI.

Detailed Description

Male and female subjects aged 18 years or older will be randomized to receive either open
surgical treatment or endovascular treatment. They will be followed for at least 2 years and
up to 4 years and 2 months after treatment to primarily assess survival and major adverse
limb events in the index or treated limb, and secondarily, to determine clinical and cost
effectiveness outcomes after treatment. These outcomes (survival-free of major limb events
and clinical, functional and cost effectiveness) will be compared within two cohorts of
subjects: those with an available single-segment great saphenous vein, and those with an
alternative conduit. The null hypotheses for both cohorts is that there will be no difference
in MALE-free survival between best endovascular therapy and best surgical therapy.


Final eligibility is determined by the health professionals conducting the trial and the protocol approved by the Committee on Human Resources (CHR) at the University of California, San Francisco (UCSF). The Patient Consent Form for this trial is available upon request. For more information about this trial, please see the full posting at

Information about this trial was obtained from the NIH Clinical Trials website, on 7/6/2018. UCSF specific information including the PI (Principal Investigator), trial enrollment status, and UCSF Study ID, supplement the study posting.
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