Systematic review and narrative synthesis of surveillance practices following endovascular intervention for lower limb peripheral arterial disease.

Abstract

OBJECTIVES\nThe optimal timing and modality of surveillance after endovascular intervention for peripheral arterial disease is controversial, and no randomised trial to assess the value of peripheral endovascular intervention has ever been performed. The aim of this systematic review was to examine the practice of surveillance following peripheral endovascular intervention in randomised trials.\n\n\nDATA SOURCES\nMedline, Embase, Cochrane Library, and WHO trial registry databases.\n\n\nMETHODS\nSystematic review of the literature was performed to capture surveillance strategies used in randomised trials comparing endovascular interventions. Surveillance protocols were assessed for completeness, modalities used, duration, and intensity.\n\n\nRESULTS\nNinety-six different surveillance protocols were reported in 103 trials comparing endovascular interventions. Protocol specification was incomplete in 32% of trials. The majority of trials used multiple surveillance modalities (mean 3.46 modalities), most commonly clinical examination (96%), ankle-brachial index (80%), duplex ultrasound (75%), and digital subtraction angiography (51%). Trials involving infrapopliteal lesions used more angiographic surveillance than trials with femoropopliteal lesions (p=0.006). The median number of surveillance visits in the first 12 months after intervention was three and the mean surveillance duration was 21 months. Trials treating infrapopliteal vessels had a higher surveillance intensity compared to those treating femoropopliteal lesions in the first 12 months after endovascular intervention (mean 5 vs. 3 surveillance visits; p=0.017). Trials with drug-eluting devices had longer surveillance duration compared to those without (mean 26 vs. 19 months; p=0.020).\n\n\nCONCLUSIONS\nThere is a high level of variation in the modality, duration, and intensity of surveillance protocols used in randomised trials comparing different types of peripheral endovascular arterial intervention. Further research is required to determine the value and impact of post-procedural surveillance on patient outcomes.