Monitoring

Your Organisational Guidance

ebpracticenet urges you to prioritise the following organisational guidance:

Revascularisatie bij perifeer vaatlijden van de onderste ledematenPublished by: KCELast published: 2015Revascularisation en cas d’artériopathie périphérique du membre inférieurPublished by: KCELast published: 2015

For those patients who have peripheral arterial disease (PAD) who are not functionally limited, an annual follow-up visit to monitor for development of coronary, cerebrovascular, and extremity disease is warranted. For patients with PAD with lifestyle-limiting claudication who benefited from conservative treatment, annual visits are recommended.

For those who required revascularisation either for claudication or limb ischaemia, careful surveillance is required.[2] Long-term patency of aortoiliac and infra-inguinal endovascular revascularisation should be monitored routinely with follow-up careful history and physical examination, ankle-brachial index (ABI), and a duplex ultrasound at regular intervals. The recommendations have been for a follow-up visit immediately in the post-endovascular period; at 1, 3, 6, 12, 18, and 24 months postoperatively; and annually thereafter. The intervals of follow-up have varied between different groups.

For infra-inguinal vein bypass grafts, patients should have a routine follow-up with careful history and physical examination, ABI, and duplex.[2][3] The surveillance should begin immediately post-operation and at regular intervals for 2 years. For femoral-popliteal and femoral-tibial venous conduit bypass, the American College of Cardiology/American Heart Association guideline recommends follow-up visits at 3, 6, 12, and 24 months. Patients should have annual follow-up visits thereafter.

For infra-inguinal prosthetic grafts, similar surveillance applies.[2] Patients should have a routine follow-up with careful history and physical examination, ABI, and duplex. The surveillance should begin immediately post-operation; at regular intervals of 3, 6, 12, 18, and 24 months; and annually thereafter.

Restenosis after revascularisation is a pervasive issue. Restenosis is a manifestation of the reparative response to vessel injury and is characterised by smooth muscle cell proliferation, migration of synthetic smooth-muscle cells to the luminal surface and deposition of extracellular matrix (intimal hyperplasia). Stents were traditionally used to bail out a complicated angioplasty (e.g., in cases of acute thrombosis, flow-limiting dissection, or significant residual stenosis >30%). Increasingly, however, stents are used as primary implants to inhibit positive vessel wall remodelling and prolong target lesion patency rates. Stents, however, also suffer from neo-intimal hyperplasia, so identifying those patients with restenosis requiring target lesion revascularisation is of particular importance. Recurrent symptoms of claudication usually precede the onset of limb- or life-threatening events in patients with lower-extremity arterial disease, and it is the recurrence of these symptoms that typically drives patient assessment.

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