Duplex Ultrasound Surveillance after Endovascular Therapy for Peripheral Arterial Disease: A Retrospective Cohort Study.

BACKGROUND

Postoperative duplex ultrasound (DUS) surveillance is common practice globally, yet there is limited evidence to demonstrate its efficacy. This study aimed to determine the incidence of adverse events in a contemporary cohort of patients undergoing post endovascular therapy DUS surveillance and to inform the design of a planned randomized controlled trial.

METHODS

A retrospective cohort study was conducted at Prince of Wales Hospital, Sydney, Australia. We reviewed consecutive patients who underwent endovascular intervention of the femoropopliteal arterial segment for symptomatic peripheral arterial disease between 2016 and 2017, with 24-month follow-up completed prior to coronavirus disease 2019 (COVID-19). The primary end point was a composite of target vessel occlusion, major adverse limb event (MALE), and/or death.

RESULTS

Forty-eight patients met inclusion criteria. The mean age was 71.9 years (range 52-92), with 52.1% male. Indications included intermittent claudication (62.5%) and chronic limb-threatening ischemia (37.5%). Trans-Atlantic Inter-Society Consensus II (TASC II) lesion classifications were as follows: type A (8.3%), type B (35.4%), type C (37.5%), and type D (18.8%). Treatment strategies included angioplasty alone (37.5%), angioplasty with stenting (60.4%) and one patient (2.1%) who received atherectomy adjunctive to drug-coated ballooning. The primary composite end point occurred in 18 patients (37.5%) over 24 months.

CONCLUSION

In this contemporary cohort, the composite end point of target vessel occlusion, MALE, or death occurred in over a third of patients within 24 months. These data support proceeding with the planned SURVEIL randomized controlled trial (ACTRN12625000889459p) and inform its eligibility criteria, end point selection, and sample size estimation.