Follow-up
Type
ModificationConfidence
92%
Created
Apr 26, 2026
Evidence
2 sources
Rationale
The stale guideline citation acc 2025 d appeared twice in this section, both times supporting claims about diabetes management, glycemic control, wound care, and limb event risk in the post-revascularization follow-up context. The superseding 2026 ACC/AHA guideline (PMID 41252847, key ACC/AHA) covers the same recommendations and replaces the older citation for both instances. No new content was added; only the citation replacement was performed as instructed. The existing citation key ACC/AHA is already listed among the chapter's existing keys, confirming it is the correct superseding reference.
Evidence
Rutherford's Vascular Surgery and Endovascular Therapy. 10th ed.. 2022. Ch. 61, Open Surgical Technique, p. 987
The advantages of fluoroscopy include the performance of a controlled thromboembolectomy with visualization of postprocedure success. There is also the opportunity for endovascular intervention when appropriate, such as balloon angioplasty and stenting of a dialysis graft venous stenosis, distal anastomosis of a femoropopliteal bypass, or occlusive iliac pathology.
Content Changes
<!-- 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 (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]years)[@rutherford-10e-2022-ch61-open-surgical-technique-p987-a679bd74] 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].[@acc2026-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].[@acc2026-d]. * **Registry 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].