Department of Surgery, University of Washington, Seattle, Wash.
Department of Surgery, Emory University, Atlanta, Ga.
J Vasc Surg. 2018 Jul;68(1):256-284. doi: 10.1016/j.jvs.2018.04.018.
Although follow-up after open surgical and endovascular procedures is generally regarded as an important part of the care provided by vascular surgeons, there are no detailed or comprehensive guidelines that specify the optimal approaches with regard to testing methods, indications for reintervention, and follow-up intervals. To provide guidance to the vascular surgeon, the Clinical Practice Council of the Society for Vascular Surgery appointed an expert panel and a methodologist to review the current clinical evidence and to develop recommendations for follow-up after vascular surgery procedures. For those procedures for which high-quality evidence was not available, recommendations were based on observational studies, committee consensus, and indirect evidence. Recognizing that there are numerous published reports on the role of duplex ultrasound for surveillance of infrainguinal vein bypass grafts, the Society commissioned a systematic review and meta-analysis on this topic. The panel classified the strength of each recommendation and the corresponding quality of evidence on the basis of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system: recommendations were graded either strong or weak, and the quality of evidence was graded high, moderate, or low. The resulting recommendations represent a wide variety of open surgical and endovascular procedures involving the extracranial carotid artery, thoracic and abdominal aorta, mesenteric and renal arteries, and lower extremity arterial revascularization. The panel also identified many areas in which there was a lack of high-quality evidence to support their recommendations. This suggests that there are opportunities for further clinical research on testing methods, threshold criteria, and the role of surveillance as well as on the modes of failure and indications for reintervention after vascular surgery procedures.
尽管开放手术和血管内治疗后的随访通常被认为是血管外科医生提供的治疗的重要组成部分，但目前还没有详细或全面的指南来具体规定测试方法、再干预指征和随访间隔的最佳方法。为了为血管外科医生提供指导，血管外科学会临床实践委员会任命了一个专家小组和一名方法学家，以审查当前的临床证据，并制定血管手术后的随访建议。对于那些没有高质量证据的手术，建议则基于观察性研究、委员会共识和间接证据。认识到有许多关于双功能超声在监测下肢静脉旁路移植中的作用的已发表报告，该学会委托对该主题进行了系统审查和荟萃分析。专家组根据推荐评估、制定和评估（GRADE）系统对每项建议的强度和相应证据质量进行了分类：建议分为强或弱，证据质量分为高、中、低。由此产生的建议代表了涉及颅外颈动脉、胸主动脉和腹主动脉、肠系膜和肾动脉以及下肢动脉血运重建的各种开放手术和血管内治疗。专家组还确定了许多缺乏高质量证据支持其建议的领域。这表明，在测试方法、阈值标准以及监测的作用、手术失败模式和血管手术后再干预指征方面，有进一步开展临床研究的机会。
