Background
Guidelines for optimal follow-up for patients undergoing lower extremity revascularization
(LER) for peripheral arterial disease recommend multiple visits with imaging during
the first year followed by yearly monitoring thereafter. Critical limb-threatening
ischemia (CLTI) patients are at a greater risk for mortality and limb amputation than
claudicants and thus necessitate closer monitoring. The goal of this article is to
study the effects of compliance with follow-up after revascularization for patients
with CLTI on major amputation rates and mortality.
Methods
A single-center retrospective chart review of consecutive patients undergoing LER
for CLTI was performed. Patients were stratified based on compliance with follow-up
to compliant or noncompliant cohorts. Patient characteristics, reinterventions, and
perioperative and long-term outcomes were compared between the 2 groups.
Results
There were 356 patients undergoing LER and 61% (N = 218) were compliant. There was no significant difference in baseline characteristics
between the 2 groups. Noncompliant patients were more likely to undergo endovascular
interventions compared to compliant patients (92.8% vs. 79.4%, P = 0.03). There was no difference in perioperative outcomes between the 2 groups with
overall 30-day mortality of 0.6%. After mean follow-up of 2.7 years, compliant patients
had greater ipsilateral reintervention rates (49.1% vs. 34.1%, P = 0.005) and overall reintervention rates (61% vs. 44.2%, P = 0.002) compared to noncompliant patients. There was no significant difference in
mortality or ipsilateral major amputations between the 2 groups.
Conclusions
Patients who were compliant with follow-up after LER for CLTI underwent more reinterventions
with no difference in mortality or major limb amputation. Further research regarding
the threshold for reintervention and the optimal schedule for follow-up in patients
with CLTI is needed.
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Article Info
Publication History
Published online: July 05, 2022
Accepted:
May 28,
2022
Received:
November 2,
2021
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 Elsevier Inc. All rights reserved.
