[Echo-doppler surveillance of revascularization of the legs in asymptomatic postoperative patients. Why? With what rhythm? How much time? How?].
OBJECTIVE
Routine duplex surveillance of patients following an arterial operation includes the scanning of symptomless patients. While the benefits of preventive correction of deteriorations, stenoses or dilatations, following aortic or lower limb arterial reconstruction are undisputed, there is no hard data on the effectiveness of this surveillance in terms of limb salvage, on its cost, and on the optimal frequency and duration.


METHODS
The AA review the literature on this subject and suggest a programme which reconciles the patients' interests with the best use of health care financial resources.


RESULTS
The possible complications depend on the type of operation. Some are symptomless. They occur mainly during the first year and less frequently, but regularly so, during the subsequent years. There is therefore no time limit for the duration of the surveillance. The effectiveness of this surveillance is low and thus the examination must be meticulous and its frequency adapted to the risks. Broadly speaking: During the first year, aorto-ilio-femoral reconstructions must be screened at one month, six months and one year; by-passes below the groin with no particular risk at six months and one year; by-passes at risk and those anastomosed to a lower leg or ankle artery require a further check-up at one month and three months. After the first year, aorto-ilio-femoral and similar by-passes must be checked annually; by-passes below the groin, when at risk, must be checked annually; in those without any particular risk, a check-up every two years seems to be sufficient. Any patient found to have a deterioration on screening must be checked every six months.


CONCLUSIONS
Careful screening is the only way of discovering a symptomless deterioration before the development of serious complications. As every arteriole reconstruction should be followed by a lifelong surveillance, in times of financial constraints the frequency of the check-ups must be tailored according to the risks present and the quality of the surveillance must be faultless.
Mellière
D
D
Service de Chirurgie Vasculaire, CHU Henri Mondor, Créteil.
Gérard
J L
JL
Bitton
L
L
Paris
D
D
Becquemin
J P
JP
D006801:Humans; D007866:Leg / Q000098:blood supply; D008403:Mass Screening / Q000379:methods*; D011182:Postoperative Care / Q000379:methods*; D019651:Plastic Surgery Procedures; D013997:Time Factors; D018608:Ultrasonography, Doppler; D014656:Vascular Surgical Procedures