Surveillance after distal revascularization for critical limb ischaemia

Scand J Surg. 2012;101(2):119-24. doi: 10.1177/145749691210100208.

Abstract

Patients with critical limb ischaemia (CLI) are usually elderly and suffer from several co-morbidities. The goal of surveillance after both endovascular and surgical revascularization for CLI is not only the protection of re-established distal perfusion and sustained ambulation but also the reduction of systemic atherothrombotic risk and mortality by ensuring continued best medical care. However, preferred format and rhythm of structured follow-up programs have remained controversial, mainly because of lack of compelling evidence. This review aims to summarize and to appraise available information critically. Thereby, it underlines the importance of systematic surveillance after both surgical and endovascular revascularization for CLI. Recent European guidelines are considered and areas of uncertainty are highlighted and discussed. According to currently available literature and recent guidelines, the early duplex scan is justified in all patients undergoing endovascular or surgical distal revascularization for CLI. There is no best level evidence supporting continued long term duplex surveillance of revascularizations with normal findings at early duplex scan, whereas those patients with abnormal early duplex scan or high risk revacularization are likely to benefit from continued duplex surveillance. Regular clinical follow-up is suggested and clinical deterioration should trigger duplex scanning to ensure revascularization patency.

Publication types

  • Review

MeSH terms

  • Angioplasty*
  • Humans
  • Ischemia / diagnostic imaging
  • Ischemia / surgery*
  • Leg / blood supply*
  • Leg / diagnostic imaging
  • Peripheral Vascular Diseases / diagnostic imaging
  • Peripheral Vascular Diseases / surgery*
  • Population Surveillance / methods*
  • Postoperative Complications / diagnostic imaging
  • Postoperative Complications / prevention & control
  • Practice Guidelines as Topic
  • Secondary Prevention / methods
  • Ultrasonography, Doppler, Duplex*
  • Vascular Grafting*