Surveillance of asymptomatic patients by duplex scanning after lower limb arterial reconstruction.

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.