Department of Vascular Surgery, Helsinki University Hospital and University of Helsinki, Finland.
Department of Cardiology, University of Liege Hospital, Belgium.
Eur J Vasc Endovasc Surg. 2019 Nov;58(5):641-653. doi: 10.1016/j.ejvs.2019.06.017.
Peripheral arterial diseases comprise different clinical presentations, from cerebrovascular disease down to lower extremity artery disease, from subclinical to disabling symptoms and events. According to clinical presentation, the patient's general condition, anatomical location and extension of lesions, revascularisation may be needed in addition to best medical treatment. The 2017 European Society of Cardiology guidelines in collaboration with the European Society for Vascular Surgery have addressed the indications for revascularisation. While most cases are amenable to either endovascular or surgical revascularisation, maintaining long-term patency is often challenging. Early and late procedural complications, but also local and remote recurrences frequently lead to revascularisation failure. The rationale for surveillance is to propose the accurate implementation of preventive strategies to avoid other cardiovascular events and disease progression and avoid recurrence of symptoms and the need for redo revascularisation. Combined with vascular history and physical examination, duplex ultrasound scanning is the pivotal imaging technique for identifying revascularisation failures. Other non-invasive examinations (ankle and toe brachial index, computed tomography scan, magnetic resonance imaging) at regular intervals can optimise surveillance in specific settings. Currently, optimal revascularisation surveillance programmes are not well defined and systematic reviews addressing long-term results after revascularisation are lacking. We have systematically reviewed the literature addressing follow-up after revascularisation and we propose this consensus document as a complement to the recent guidelines for optimal surveillance of revascularised patients beyond the perioperative period.
外周动脉疾病包括不同的临床表现，从脑血管疾病到下肢动脉疾病，从亚临床症状到致残性症状和事件。根据临床表现、患者的一般情况、病变的解剖位置和范围，除了最佳的药物治疗外，可能还需要血运重建。2017 年欧洲心脏病学会与欧洲血管外科学会合作制定了血运重建的适应证。虽然大多数病例适合血管内或手术血运重建，但维持长期通畅常常具有挑战性。早期和晚期的程序并发症，以及局部和远处的复发，经常导致血运重建失败。监测的基本原理是提出准确实施预防策略，以避免其他心血管事件和疾病进展，并避免症状复发和需要再次血运重建。结合血管病史和体格检查，双功能超声扫描是识别血运重建失败的关键影像学技术。其他非侵入性检查（踝臂指数、计算机断层扫描、磁共振成像）在特定情况下可以定期进行优化监测。目前，还没有很好地定义最佳的血运重建监测方案，也缺乏针对血运重建后长期结果的系统评价。我们系统地回顾了关于血运重建后随访的文献，并提出了这份共识文件，作为对最近血管重建患者术后监测最佳实践指南的补充。
