Monitoring
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 revascularization either for claudication or limb ischemia, careful surveillance is required.[2] Long-term patency of aortoiliac and infrainguinal endovascular revascularization should be monitored routinely with follow-up careful history and physical exam, ankle-brachial index (ABI), and a duplex ultrasound at regular intervals. The recommendations have been for a follow-up visit immediately in the postendovascular 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 infrainguinal vein bypass grafts, patients should have a routine follow-up with careful history and physical exam, 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 infrainguinal prosthetic grafts, similar surveillance applies.[2] Patients should have a routine follow-up with careful history and physical exam, 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 revascularization is a pervasive issue. Restenosis is a manifestation of the reparative response to vessel injury and is characterized 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 remodeling and prolong target lesion patency rates. Stents, however, also suffer from neointimal hyperplasia, so identifying those patients with restenosis requiring target lesion revascularization 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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