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
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].