D. Melliere et al., Surveillance of asymptomatic patients by duplex scanning after lower limb arterial reconstruction., J MAL VASC, 24(3), 1999, pp. 233-238
Aim: Routine duplex surveillance of patients following an arterial operatio
n includes the scanning of symptomless patients. While the benefits of prev
entive correction of deteriorations, stenoses or dilatations, following aor
tic 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 program
me which reconciles the patients' interests with the best use of healthcare
financial resources.
Results: The possible complications depend on the type of operation. Some a
re 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 surv
eillance is low and thus the examination must be meticulous and its frequen
cy adapted to the risks.
Broadly speaking:
During the first year, aortoiliofemoral reconstructions must be screened at
one month, six months and one year; by-passes below the groin with no part
icular risk at six months and one year; by-passes at risk and those anastom
osed to a lower leg or ankle artery require a further check-up at one month
and three months.
After the first year, aortoiliofemoral and similar by-passes must be checke
d annually; by-passes below the groin, when at risk, must be checked annual
ly; 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 ever
y six months.
Conclusion : Careful screening is the only way of discovering a symptomless
deterioration before the development of serious complications. As every ar
teriol reconstruction should be followed by a lifelong surveillance, in tim
es of financial constraints the frequency of the check-ups must he tailored
according to the risks present and the quality of the surveillance must be
faultless.