Key Points
➤ All vascular procedures have modes of failure that must be identified and
managed appropriately to provide the best possible long-term results.
➤ It is generally accepted that achieving optimal outcomes from open
surgical and endovascular procedures depends on periodic follow-up and
appropriate reintervention.
➤ The options for follow-up range from a simple vascular history and physical
examination (often including ankle-brachial index [ABI] measurement for
procedures involving the lower extremity arteries) to sophisticated imaging
methods such as computed tomography (CT) or magnetic resonance (MR)
angiography and more invasive catheter angiography.
➤ Noninvasive vascular laboratory tests, particularly duplex ultrasound
(DUS), are ideally suited for this purpose because they are safe and
relatively low in cost, and they provide objective anatomic and physiologic
information that can be used to assess the durability of a vascular
intervention over time.
➤ The goal of routine surveillance is to identify intervention sites that are at
risk for failure, even in the absence of signs or symptoms. However, this
approach is justified only if the consequences of failure are severe and
early reintervention can improve the outcome.
➤ Additional requirements are the availability of accurate testing methods
with clinically relevant threshold criteria and appropriate follow-up or
testing intervals.
