Chapter VI: Follow-up after revascularisation

Area of Science:

• Vascular Surgery
• Cardiovascular Medicine
• Clinical Guidelines

Background:

• Chronic critical limb ischaemia (CLI) management requires structured follow-up post-revascularisation for sustained success and optimal patient care.
• Current guidelines inadequately address CLI follow-up, often assuming initial revascularisation efficacy dictates prognosis.
• CLI patients are frequently elderly and frail, making preserved ambulatory capacity vital for independent living and overall prognosis.

Purpose of the Study:

• To challenge the neglect of post-CLI revascularisation follow-up in existing guidelines.
• To recommend evidence-based best clinical practices for CLI follow-up.
• To critically appraise evidence across medical therapy, surveillance, and repeat interventions.

Main Methods:

• Systematic review and critical appraisal of available evidence on structured follow-up domains for CLI.
• Analysis of antiplatelet/antithrombotic therapy, clinical surveillance, and duplex ultrasound use.
• Evaluation of indications and types of repeat interventions for failing or failed reconstructions.

Main Results:

• Evidence for specific CLI follow-up strategies is limited, often requiring extrapolation from broader patient populations.
• Recommendations are frequently based on subgroup analyses, leading to a degradation in evidence strength.
• Endovascular and surgical approaches, along with specific comorbidities like diabetes and renal failure, are considered separately.

Conclusions:

• Structured follow-up is essential for chronic critical limb ischaemia (CLI) patients post-revascularisation.
• Key components include optimizing medical therapy, diligent surveillance of arterial reconstruction, and prompt repeat interventions.
• Future research is needed to strengthen the evidence base for CLI follow-up protocols.