OUTPATIENT-CLINIC REVIEW AFTER ARTERIAL RECONSTRUCTION - IS IT NECESSARY

After arterial reconstruction, patients have traditionally been follow ed up in clinic in the long term. We have pursued a policy of limited clinic follow-up, with an 'open access' service for suspected graft fa ilure (and latterly duplex scanning surveillance for vein grafts). Thi s policy was assessed by measurement of the success of self-referral, graft patency and patient satisfaction after operation for lower limb ischaemia in 173 patients. At median follow-up of 50 months, 61 (35%) patients had died and 45 (25%) had required amputation. Of those with salvaged limbs and available for follow-up, 55 (86%) patients reported continuing symptomatic improvement with a graft patency rate of 80%. During the review period, 27 (42%) patients had presented themselves o n suspicion of graft occlusion and 14 (52%) of these had required surg ical intervention. Of the patients, 45 (70%) found a single postoperat ive clinic visit helpful, and the majority thought that further visits would not have been helpful to them. Limited clinic appointments seem especially desirable for elderly patients for whom journeys are an im position, as well as reducing travel costs, and giving surgeons more t ime to deal with new referrals. These results suggest that properly ed ucated patients present themselves when signs of graft occlusion occur , and there is little to be gained by regular long-term clinic follow- up in vascular surgical practice.