Vascular Surgery Arterial Procedures Clinical Practice Guidelines (2018)

Society for Vascular Surgery

Reviewed and summarized by Medscape editors

August 09, 2018

The clinical practice guidelines on vascular surgery arterial procedures were released in July 2018 by the SVS.[1]

After carotid endarterectomy (CEA) or carotid artery stenting (CAS), recommend surveillance with duplex ultrasound (DUS) at baseline and every 6 months for 2 years and annually thereafter until stable (ie, until no restenosis or in-stent restenosis (ISR) is observed in two consecutive annual scans). The first or baseline DUS should occur soon after the procedure, preferably within 3 months, with the goal of establishing a post-treatment baseline. Considering the small risk of delayed restenosis or ISR, some interval of regular surveillance (eg, every 2 years) should be maintained for the life of the patient.

For patients undergoing CAS with diabetes, aggressive patterns of ISR (type IV), prior treatment for ISR, prior cervical radiation, or heavy calcification, in addition to the baseline DUS, we recommend surveillance with DUS every 6 months until a stable clinical pattern is established and annually thereafter.

Recommend that DUS after CAS include at least the following assessments: (A) Doppler measurement of PSV and EDV in the native CCA; in the proximal, mid, and distal stent; and in the distal native ICA. Modified threshold velocity criteria should be used to interpret the significance of these velocity measurements after CAS. (B) B-mode imaging should be used to supplement and to enhance the accuracy of velocity criteria to estimate the severity of luminal narrowing.

Recommend contrast-enhanced CT scanning at 1 month and 12 months and then annually after thoracic endovascular aortic repair (TEVAR) for thoracic aortic aneurysm. If the 1-month CT scan detects an abnormality, a repeated CT scan at 6 months should be considered.

Recommend contrast-enhanced CT scanning at 1 month, 6 months, and 12 months and then annually after TEVAR for thoracic aortic dissection.

Recommend contrast-enhanced CT scanning at 1 month and 12 months and then annually after TEVAR for blunt thoracic aortic injury. If the 1-month CT scan detects an abnormality, a repeated CT scan at 6 months should be considered. Future studies may provide data to support longer surveillance intervals after TEVAR for traumatic injury once a stable clinical pattern is established.

Recommend CT scanning with or without contrast enhancement at 5-year intervals after open surgical repair for thoracic aortic disease.

Recommend total aortic imaging with non-contrast-enhanced CT scanning at 5-year intervals after open surgical repair or EVAR to detect aneurysmal degeneration of other aortic segments.

Recommend clinical examination and ankle-brachial index (ABI), with or without the addition of DUS, in the early postoperative period to provide a baseline for further follow-up after aortobifemoral bypass. This evaluation should be repeated at 6 and 12 months and then annually as long as there are no new signs or symptoms.

Recommend clinical examination and ABI, with or without the addition of DUS, in the early postoperative period to provide a baseline for further follow-up after iliofemoral bypass. This evaluation should be repeated at 6 and 12 months and then annually as long as there are no new signs or symptoms.

Recommend clinical examination and ABI, with or without the addition of DUS, in the early postoperative period to provide a baseline for further follow-up after femoral-femoral bypass. This evaluation should be repeated at 6 and 12 months and then annually as long as there are no new signs or symptoms.

Recommend clinical examination and ABI, with or without the addition of DUS, in the early postoperative period to provide a baseline for further follow-up after axillobifemoral bypass. This evaluation should be repeated at 6 and 12 months and then annually as long as there are no new signs or symptoms.

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