Duplex surveillance of lower extremity endovascular interventions

Endovascular techniques have been rapidly implemented into the surgical armamentarium for the treatment of infrainguinal arterial occlusive disease. Despite high initial technical success rates, all endovascular interventions in the femoropopliteal- tibial arterial distribution are associated with a significant restenosis and failure rate. Strategies to improve the durability of endovascular therapy need to be developed and should include medical therapy and surveillance testing to detect hemodynamic failure that typically precedes thrombotic occlusion. Duplex ultrasound can accurately identify the abnormal, stenosed angioplasty site, but the threshold criteria that predict thrombosis have not been defined. Duplex ultrasound surveillance protocols are designed to identify residual stenosis, which is associated with lower patency rates, and by serial testing, the development of a progressive, high-grade stenosis. The decision to reintervene and correct the angioplasty site lesion should be individualized based on patient characteristics, the clinical implication of angioplasty failure, and efficacy of secondary interventions in prolonging functional patency.