ANZ journal of surgery · 2025
Duplex Ultrasound Surveillance After Endovascular Therapy for Peripheral Artery Disease: An Australian and New Zealand Study.
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Warburton Thomas M, Thomas Shannon D, Khashram Manar, Subramaniam Peter, Picazo-Pineda Fernando, Joseph Simon, Lennox Andrew F, Katib Nedal, Varcoe Ramon L
Аннотация
OBJECTIVE: Current practice guidelines lack consensus on optimal surveillance strategies following endovascular interventions for peripheral artery disease (PAD). This study evaluated surveillance practices among vascular surgeons in Australia and New Zealand (ANZ), focusing on duplex ultrasound (DUS) use and factors influencing surveillance protocols.
METHODS: All consultant vascular surgeons in the Australian and New Zealand Society for Vascular Surgery were invited to participate in an online survey examining demographics, practice characteristics, surveillance protocols after endovascular interventions, and decision-making regarding surveillance and reintervention.
RESULTS: Of 266 surgeons, 73 responded (27%). Respondents were predominantly experienced (77% with ≥ 10 years practice) and worked in teaching hospitals (88%). Most performed an initial post-procedural DUS (89%) and ongoing routine DUS surveillance (83%). Surveillance protocols varied considerably, with 67% tailoring intervals based on patient/lesion factors rather than predetermined schedules. Practice variation was independent of surgeon experience, practice setting, or geography. All surveyed chronic limb-threatening ischemia patients, versus 93% for intermittent claudication. Reintervention thresholds varied by anatomy: 58% required symptoms before intervening for infrapopliteal disease compared to 15% for aortoiliac disease. Most surgeons (82%) acknowledged significant uncertainty regarding optimal surveillance strategies.
CONCLUSION: Substantial practice variation exists in post-endovascular surveillance among ANZ vascular surgeons. While most employ DUS surveillance, frequency, duration, and intervention thresholds differ markedly. These findings highlight the need for prospective studies to determine optimal surveillance protocols balancing clinical outcomes with resource utilization.
METHODS: All consultant vascular surgeons in the Australian and New Zealand Society for Vascular Surgery were invited to participate in an online survey examining demographics, practice characteristics, surveillance protocols after endovascular interventions, and decision-making regarding surveillance and reintervention.
RESULTS: Of 266 surgeons, 73 responded (27%). Respondents were predominantly experienced (77% with ≥ 10 years practice) and worked in teaching hospitals (88%). Most performed an initial post-procedural DUS (89%) and ongoing routine DUS surveillance (83%). Surveillance protocols varied considerably, with 67% tailoring intervals based on patient/lesion factors rather than predetermined schedules. Practice variation was independent of surgeon experience, practice setting, or geography. All surveyed chronic limb-threatening ischemia patients, versus 93% for intermittent claudication. Reintervention thresholds varied by anatomy: 58% required symptoms before intervening for infrapopliteal disease compared to 15% for aortoiliac disease. Most surgeons (82%) acknowledged significant uncertainty regarding optimal surveillance strategies.
CONCLUSION: Substantial practice variation exists in post-endovascular surveillance among ANZ vascular surgeons. While most employ DUS surveillance, frequency, duration, and intervention thresholds differ markedly. These findings highlight the need for prospective studies to determine optimal surveillance protocols balancing clinical outcomes with resource utilization.