Dunn J M, Elliott T B, Lavy J A, Bell A, Kernick V F, Campbell W B
Royal Devon & Exeter Hospital, Wonford.
Ann R Coll Surg Engl. 1994 Sep;76(5):304-6.
After arterial reconstruction, patients have traditionally been followed up in clinic in the long term. We have pursued a policy of limited clinic follow-up, with an 'open access' service for suspected graft failure (and latterly duplex scanning surveillance for vein grafts). This policy was assessed by measurement of the success of self-referral, graft patency and patient satisfaction after operation for lower limb ischaemia in 173 patients. At median follow-up of 50 months, 61 (35%) patients had died and 45 (25%) had required amputation. Of those with salvaged limbs and available for follow-up, 55 (86%) patients reported continuing symptomatic improvement with a graft patency rate of 80%. During the review period, 27 (42%) patients had presented themselves on suspicion of graft occlusion and 14 (52%) of these had required surgical intervention. Of the patients, 45 (70%) found a single postoperative clinic visit helpful, and the majority thought that further visits would not have been helpful to them. Limited clinic appointments seem especially desirable for elderly patients for whom journeys are an imposition, as well as reducing travel costs, and giving surgeons more time to deal with new referrals. These results suggest that properly educated patients present themselves when signs of graft occlusion occur, and there is little to be gained by regular long-term clinic follow-up in vascular surgical practice.
传统上，动脉重建术后患者需长期在门诊接受随访。我们采取了有限门诊随访政策，对于疑似移植物失败的情况提供“开放就诊”服务（后来对静脉移植物进行双功超声扫描监测）。通过测量173例下肢缺血手术患者自我转诊的成功率、移植物通畅率和患者满意度来评估该政策。在中位随访50个月时，61例（35%）患者死亡，45例（25%）患者需要截肢。在那些肢体得以挽救且可供随访的患者中，55例（86%）患者报告症状持续改善，移植物通畅率为80%。在回顾期内，27例（42%）患者因怀疑移植物闭塞前来就诊，其中14例（52%）需要手术干预。45例（70%）患者认为术后单次门诊就诊有帮助，大多数患者认为进一步就诊对他们没有帮助。有限的门诊预约对于那些出行不便的老年患者似乎尤其必要，同时还能降低交通成本，并让外科医生有更多时间处理新的转诊患者。这些结果表明，接受适当教育的患者在出现移植物闭塞迹象时会自行前来就诊，在血管外科实践中，定期进行长期门诊随访几乎没有益处。
