title: Surveillance and follow-up after revascularization for critical limb ischemia.
abstract: The purpose of a structured and cost-effective surveillance program after surgical or endovascular intervention for critical limb ischemia is to optimize limb salvage and preserve arterial repair function. Surveillance programs should include clinical, vascular laboratory, and radiographic follow-up, and, when a high-grade progressive stenosis is identified, appropriately timed intervention should be performed. Because many patients with critical limb ischemia are older and many are frail with limited mobility, optimizing the durability of arterial intervention and keeping these patients ambulatory is an important factor in retaining an independent lifestyle and quality of life. Despite the importance of surveillance after arterial intervention, there is a lack of consensus in the literature regarding the efficacy of surveillance, how it should be performed, and well-defined evidence-based guidelines. This review provides an up-to-date scrutiny on this topic and provides recommendations for optimal testing methods, limitations of surveillance testing, and when and how to intervene. These recommendations should be considered in the care of the patient with critical limb ischemia, but with the understanding that patients vary widely and care should be individualized.
authors: Division of Vascular and Endovascular Surgery, Sulpizio Cardiovascular Center, University of California, San Diego School of Medicine, 9434 Medical Center Drive, Mail Code 7403, La Jolla, CA 92037. Electronic address: abarleben@ucsd.edu.
authors: Andrew
authors: A
authors: Barleben
authors: Division of Vascular and Endovascular Surgery, Sulpizio Cardiovascular Center, University of California, San Diego School of Medicine, 9434 Medical Center Drive, Mail Code 7403, La Jolla, CA 92037.
authors: Dennis F
authors: DF
authors: Bandyk
mesh_terms: D003362:Cost-Benefit Analysis; D016638:Critical Illness; D003952:Diagnostic Imaging / Q000379:methods*; D057510:Endovascular Procedures / Q000009:adverse effects; D005121:Extremities / Q000098:blood supply*; D017048:Health Care Costs; D006801:Humans; D007511:Ischemia / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D023821:Limb Salvage; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D010808:Physical Examination / Q000379:methods*; D011182:Postoperative Care; D011183:Postoperative Complications / Q000175:diagnosis* / Q000628:therapy; D011237:Predictive Value of Tests; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects