Promoting an increased awareness and standardized approaches in diagnosing and treating peripheral artery disease

PERIPHERAL ARTERY DISEASE (PAD)

Follow-Up after Revascularization

The frequency and modality used to monitor patients after revascularization vary significantly among providers. In 2012, a multi-society criterion for the appropriate use of peripheral vascular ultrasound and physiologic testing was produced (34). Given the paucity of quality, randomized data on the topic of post-revascularization monitoring, the 2012 document suggested that the following were appropriate (A):

  1. A new baseline duplex ultrasound with single level ABI and PVR (Duplex/ABI) within the first month after revascularization
  2. Repeat testing with new or worsening symptoms any time after revascularization
  3. Repeat testing 6 to 8 months after venous or prosthetic bypass grafting
  4. Repeat testing every 12 months in post-intervention and post-bypass patients

Most recently, in the 2016 AHA/ACC guideline strong endorsements were offered for periodic clinical evaluation and ABI after surgical or percutaneous revascularization (LOE I). Duplex ultrasound after intervention (LOE IIa), autologous vein bypass (LOE IIa), and infrainguinal prosthetic bypass (LOE IIb) were endorsed less vigorously.

References

34. Mohler, E. (2012). 2012 Appropriate Use Criteria for Peripheral Vascular Ultrasound and Physiologic Testing Part I: Arterial Ultrasound and Physiologic Testing. Journal of the American College of Cardiology, 60(3):242-76.