Follow-up

<!-- type: surveillance -->
**Post-Revascularization Surveillance Protocol**

| **Modality** | **1 mo** | **6 mo** | **12 mo** | **Annual** |
| --- | --- | --- | --- | --- |
| Duplex ultrasound (DUS) | ✓ | ✓ | ✓ | ✓ |
| ankle-brachial index (ABI)/toe-brachial index (TBI) | ✓ | ✓ | ✓ | ✓ |
| Clinical exam | ✓ | | | |

* **Surveillance:**
  + Duplex ultrasound (DUS) at 1, 6, and 12 months post-intervention, then annually,[@ahaacc2016, @almasri2018] to detect hemodynamically significant restenosis (PSV(peak systolic velocity [PSV] ratio >2.5 or >50% diameter reduction).[@moneta2010]
  + Ankle-brachial index (ABI) or toe-brachial index (TBI)[@potier2011] and clinical examination at each visit to assess functional status and symptom recurrence.
* **Restenosis:**
  + More frequent after endovascular intervention (30–60% at 1–2 years)[@rutherford2018-rutherford] than open bypass. Hemodynamically significant restenosis (>70% stenosis or symptoms) warrants reintervention with repeat angioplasty, stenting, or conversion to bypass.
* **Medical therapy:** Lifelong antiplatelet therapy (aspirin or clopidogrel) and high-intensity statin therapy are mandatory to reduce systemic cardiovascular events and improve graft patency. Consider dual-pathway inhibition (rivaroxaban 2.5 mg BID + aspirin) in appropriate candidates post-revascularization.[@voyager2020] In patients with diabetes mellitus, optimized glycemic control and comprehensive management of metabolic risk factors are essential to mitigate the high risk of major adverse limb events (MALE) and cardiovascular complications [@acc2025-d].
* **Wound care:** Multidisciplinary wound management—including pressure offloading, debridement, infection control, and glycemic optimization—is essential in chronic limb-threatening ischemia (CLTI) patients to maximize limb salvage after revascularization. This integrated approach is particularly critical for patients with diabetes to ensure timely healing and prevent recurrence [@acc2025-d].
* **Registry participation:**participation and Outcomes:** National registries (e.g., Swedvasc, Vascunet) track long-term outcomes and provide quality benchmarks for institutional performance evaluation and continuous quality improvement.[@mani2020, @swedvasc2022, @vascunet2019] Surveillance and registry data should also account for socioeconomic status (SES), as lower SES is associated with poorer long-term outcomes and higher rates of major amputation following vascular interventions [@anon2024-systematic].