Follow-up of patients after revascularisation for peripheral arterial diseases: a consensus document from the European Society of Cardiology Working Group on Aorta and Peripheral Vascular Diseases and the European Society for Vascular Surgery

Abstract

Peripheral arterial diseases comprise different clinical presentations, from cerebrovascular disease down to lower extremity artery disease, from subclinical to disabling symptoms and events. According to clinical presentation, the patient's general condition, anatomical location and extension of lesions, revascularisation may be needed in addition to best medical treatment. The 2017 European Society of Cardiology guidelines in collaboration with the European Society for Vascular Surgery have addressed the indications for revascularisation. While most cases are amenable to either endovascular or surgical revascularisation, maintaining long-term patency is often challenging. Early and late procedural complications, but also local and remote recurrences frequently lead to revascularisation failure. The rationale for surveillance is to propose the accurate implementation of preventive strategies to avoid other cardiovascular events and disease progression and avoid recurrence of symptoms and the need for redo revascularisation. Combined with vascular history and physical examination, duplex ultrasound scanning is the pivotal imaging technique for identifying revascularisation failures. Other non-invasive examinations (ankle and toe brachial index, computed tomography scan, magnetic resonance imaging) at regular intervals can optimise surveillance in specific settings. Currently, optimal revascularisation surveillance programmes are not well defined and systematic reviews addressing long-term results after revascularisation are lacking. We have systematically reviewed the literature addressing follow-up after revascularisation and we propose this consensus document as a complement to the recent guidelines for optimal surveillance of revascularised patients beyond the perioperative period.

Evaluation of Clinical Outcomes After Revascularization in Patients With Chronic Limb-Threatening Ischemia: Results From a Prospective National Cohort Study (RIVALUTANDO)

“…In 2019, a consensus from the European Society of Cardiology and the European Society of Vascular and Endovascular Surgery 18 stated that restenosis and occlusion range from 5% in the inguinal district to >50% in the infrapopliteal district, recording an almost uniform rate of failure over 5 years from revascularization with improved risk of limb loss. So endothelial dysfunction and hyperplasia reaction seem to be the key points to address so as to prolong the benefit of revascularization.…”

The Upper-Arm Basilic-Cephalic Loop: A Valueable Alternative for Below-Knee Arterial Reconstruction

“…The need for frequent clinical follow-up and ultrasound assessments has been highlighted before including the recent ESVS guidelines. 26 -28…”

One step behind – although incidence decreases, mortality in patients with lower-extremity arterial disease (LEAD) lags behind cardiovascular disease

“…The European Society of Cardiology Working Group on Aorta and Peripheral Vascular Diseases and the European Society for Vascular Surgery have also defined a checklist to underline specific aspects of follow-up in LEAD patients (Table 1). 8 In conclusion, LEAD and CAD patients share a common disease, highly responsive to the control of risk factors, optimization of protective medication and implementation of lifestyle measures. Although still underused, CAD patients profit from cardiac rehabilitation programmes as sites of implementation of secondary prevention measures.…”

“…7 Although most patients with LEAD are amenable to either endovascular or surgical revascularization, the maintenance of long-term patency in particular and prognosis in general is obviously challenging. 8 Therefore, short-, mid-and long-term follow-up of LEAD patients must be improved. Structured secondary preventive programmes, including risk factor management, psychosocial support and exercise training, are particularly suitable for the implementation of the strategies to stop disease progression respecting the patient's age, comorbidities and physical frailty in setting the appropriate targets.…”

“…Table 1. Checklist of items to be regularly assessed during follow-up of lower-extremity arterial disease patients (modified from Venermo et al 8 ).…”