A Comparison of Specialties Participating in the BEST-CLI Trial to Specialists Treating Peripheral Arterial Disease Nationally

Abstract

The Best Endovascular vs Best Surgical Therapy in Patients with Critical Limb Ischemia (BEST-CLI) trial compares open surgery (OPEN) and endovascular therapy (ENDO) for treatment of critical limb ischemia. This report describes the investigator specialties participating in BEST-CLI and compares them with specialists treating peripheral vascular disease (PAD) nationally. To be credentialed, a BEST-CLI investigator must be approved by the site investigator and the Surgical and Interventional Management Committee of BEST-CLI. Investigators also sign an attestation confirming completion of at least 12 below-knee interventions in the last 2 years for ENDO approval and 10 lower extremity bypass procedures during 2 years for OPEN. Investigators within their first year of practice were conditionally approved and performed procedures with fully approved investigators; 10% of sites are audited to confirm attestations. The type and proportion of specialists credentialed in BEST-CLI were compared with those treating PAD on a national basis by auditing 10% of Medicare claims for PAD. A total of 865 physicians are credentialed to enroll in BEST-CLI. Of these, 596 (69%) are vascular surgeons, 128 (15%) are interventional cardiologists, 123 (14%) are interventional radiologists, 7 (1%) are vascular medicine specialists, and 11 (1%) are other. Of the 596 vascular surgeons enrolling in the trial, 113 (19%) are credentialed to do OPEN only, 409 (69%) are credentialed to do both OPEN and ENDO, and 3 (1%) are credentialed to do only ENDO. Of the remaining 71 vascular surgeons, 50 were conditionally approved for both, 8 were conditionally approved for OPEN only, and 13 were nonoperators. Of the 136 centers enrolling patients, multispecialty involvement occurs in 98 (72%). Endovascular treatment by specialty in BEST-CLI vs national Medicare claims is as follows: vascular surgeons, 55% vs 51%; interventional cardiologists, 17% vs 13%; interventional radiologists, 16% vs 25%; and other, 2% vs 10%. BEST-CLI contains a diverse group of specialists enrolling and treating patients with critical limb ischemia. Whereas a majority of the practitioners are vascular surgeons who do both open and endovascular procedures, a broad variety of specialists are represented in a pattern that represents national treatment patterns outside of the BEST-CLI trial. These treatment patterns ensure that findings from BEST-CLI are applicable to the real-world practice of treatments for PAD.