European Societies Publish Consensus Document on Follow-Up After Revascularization for PAD

November 14, 2019—A consensus document from European societies on the follow-up of patients after revascularization for peripheral artery disease (PAD) was published by Maarit Venermo, MD, et al in the European Journal of Vascular and Endovascular Surgery (2019;58:641–653). The document was created by the European Society of Cardiology Working Group on Aorta and Peripheral Vascular Diseases and the European Society for Vascular Surgery.

As stated in the conclusion of the consensus document, “This paper aims to provide a standardized follow-up approach, based on a combination of evidence and authors' expertise, emphasizing the importance of multidisciplinary management of these patients with an optimal, clinically reasonable, and cost-effective strategy. This collaborative work highlights many gaps in the evidence and suggests collaborative research to provide further data and evidence in this setting.”

The document is divided into considerations of mid-term and long-term complications after revascularization, patient clinical follow-up, and imaging techniques.

Additionally, sections are devoted to these anatomic areas of treatment:

• Extracranial carotid artery disease
• Upper extremity artery disease
• Mesenteric artery disease
• Renal artery disease
• Lower extremity artery disease, including special aspects after revascularization for chronic limb-threatening ischemia

The investigators noted that optimal revascularization surveillance programs are not well defined and systematic reviews addressing long-term results after revascularization are lacking.

For this update, they have systematically reviewed the literature addressing follow-up after revascularization and the consensus document is proposed as a complement to the recent guidelines for optimal surveillance of revascularized patients beyond the perioperative period.

The document addresses the range of PAD composed of different clinical presentations, from cerebrovascular disease down to lower extremity artery disease, from subclinical to disabling symptoms and events. Revascularization may be needed in addition to best medical treatment based on the clinical presentation of the patient’s general condition, anatomic location, and extension of lesions, as noted in the document.

According to the investigators, most cases of PAD are amenable to either endovascular or surgical revascularization, however, maintaining long-term patency is often challenging. Early and late procedural complications, as well as local and remote recurrences frequently lead to revascularization failure.

The rationale for surveillance is to propose the accurate implementation of preventive strategies:

• to avoid other cardiovascular events and disease progression
• to avoid recurrence of symptoms and the need for redo revascularization

Combined with vascular history and physical examination, duplex ultrasound scanning is the pivotal imaging technique for identifying revascularization failures. Other noninvasive examinations (ankle and toe brachial index, CT scan, MRI) at regular intervals can optimize surveillance in specific settings, stated the investigators in the summary of the consensus document.