When Should Patients with Vascular Disease Have Follow-up Noninvasive Vascular Examinations?
Noninvasive vascular duplex testing plays an increasingly prevalent role in the long-term care of patients with significant vascular disease. Several factors have propelled this trend. These include the progressive nature of atherosclerosis, the noninvasive nature of the testing, the importance of early intervention for long-term graft patency, and the modality's increased accuracy and availability.
This trend has naturally raised a cost/benefit issue since even though duplex is relatively inexpensive versus arteriography, long-term surveillance and repeat testing can be costly. Over the past few years, it has been shown to Medicare's and the vascular surgery community's satisfaction, that appropriate duplex follow-up is cost effective when all factors are considered. Still, the question remains, what are the appropriate guidelines for follow-up studies? In an effort to address this question an ad hoc committee of the Western Vascular Surgery Society developed guidelines to help practitioners and third party payers. The guidelines were published in the Journal of Vascular Surgery (1992:16, 163-170). Independently, we had developed minimum recommendations at the Vascular Diagnostic Center. We hope the following chart will prove helpful in long-term care of your patients with vascular disease.
Guidelines for Follow-up
| Disease Location | Patient Status | Vascular Diagnostic Center | Western Vascular Surgical Society* |
| Carotid | Non-operative 20-50% stenosis 50-79% stenosis | 4, 10 months, annual if symptoms or >60% blockage, or at 3 years w/o symptoms no follow-up generally recommended generally annual examination if >60% | 6 weeks, 6 months, 12 months annually thereafter annually thereafter every 6 months |
| Lower Extremity Arterial | Postoperative Non-operative Claudication | 4, 10 months, then every 6 months if claudication, rest pain, or ulcers are noted follow-up may be recommended | regular monitoring, frequency depends on procedure follow-up reasonable |
| Aorto-Iliac | Postoperative Non-operative Claudication | 4, 10 months, then every 6 months if claudication, rest pain, or ulcers are noted follow-up may be recommended | regular monitoring, frequency depends on procedure follow-up reasonable |
| Abdominal Aortic Aneurysm | Non-operative Monitoring | every 6 months | every 6 months |
| Renal | Postoperative | 4, 10 months, annually thereafter | regular to evaluate success of intervention |
| Upper extremities | Postoperative | 4, 10 months, annually thereafter | regular monitoring, frequency depends on procedure |
| In-situ & Reverse Vein | Postoperative | every 3 months, if asymptomatic after 1 year | every 3 months in year 1, at 6 months in year 2 and annually thereafter |
| Embolectomy | Postoperative | 4 months only | as appropriate to assure patency |
*Source: Journal of Vascular Surgery 1992:16,163-170
