Original Article   

International Angiology 2022 Jun 29

DOI: 10.23736/S0392-9590.22.04900-8

Copyright © 2022 EDIZIONI MINERVA MEDICA

language: English

Routinely ultrasound surveillance improves outcome after endovascular treatment of peripheral arterial disease. Propensity-matched comparisons of clinical outcomes after ultrasound or clinical-haemodynamic based surveillance programs

Carlos MARTÍNEZ-RICO ^{1, 2} ✉, Xavier MARTÍ-MESTRE ^{1, 2}, Dolors CERVELLERA-PÉREZ ¹, Ricard RAMOS-IZQUIERDO ^{2, 3}, Jonas EIBERG ⁴, Ramon VILA-COLL ^{1, 2}

¹ Department of Endovascular and Vascular Surgery, Bellvitge University Hospital, Hospitalet de Llobregat, Barcelona, Spain; ² Institut Investigació Biomèdica de Bellvitge (IDIBELL), Hospitalet de Llobregat, Barcelona, Spain; ³ Department of Thoracic Surgery, Bellvitge University Hospital, Hospitalet de Llobregat, Barcelona, Spain; ⁴ Copenhagen Academy for Medical Education and Simulation (CAMES), Department of Vascular Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark

BACKGROUND: Endovascular treatment (EVT) has replaced open repair as the first option in intermittent claudication (IC) and chronic limb-threatening ischaemia (CLTI) in several centres. However, evidence of the most optimal post-procedural surveillance strategy is sparse. This study aimed to compare two routine surveillance programs after EVT of IC/CLTI: clinical and haemodynamic assessment (CHA) vs duplex ultrasound (DUS) and clinical/haemodynamic assessment in combination.
METHODS: Between February 2012 and December 2015, all patients with EVT of IC/CLTI were allocated to either CHA or DUS-based routine surveillance programs. The allocation-ratio was 1:2 (CHA:DUS), and propensity score matching (PSM) was used to control baseline differences between the groups. Follow-up visits in the CHA group consisted of clinical assessment and ABI at 3,6, 12 and 24 months. Follow-up visits in DUS group consisted of clinical assessment, ABI, and target vessel DUS at 1, 3, 6, 12, 18 and 24 months.
RESULTS: In total, 340 legs in 305 patients suffering from IC/CLTI were included; 111 (33%) in the CHA-group and 229 (67%) in the DUS group. The two groups were identical except for a significantly lower incidence of diabetes mellitus in the CHA group than the DUS group, 55% vs 72%, respectively (p:.006). Based on PSM, the CHA-group vs the DUS-group was burdened of an increased risk of amputation (12.5% vs 8.27%, HR 0.41 (95% CI, 0.17-0.96)), and a higher mortality (21.2% vs 12.8%, HR 0.37 (95% CI, 0.19-0.72)). The reported differences in reintervention rate (7.5% vs 12.8%, HR 1.12 (95% CI, 0.44-2.84)) was insignificant. The mean follow-up was 317 days (SD: 214) in the CHA group and 611 days (SD: 298) in the DUS group.
CONCLUSIONS: Our results suggest that DUS-based routine surveillance after EVT of IC/CLTI is superior to CHA-based routine surveillance in improved amputation rate and mortality.

KEY WORDS: Doppler ultrasound; Endovascular treatment; Peripheral arterial disease; Limb salvage