PVD Follow-up/ Reassessment

Vascular: PVD Follow-up/ Reassessment

Patients with carotid and peripheral vascular disease require lifelong surveillance to minimize the longterm risk from progression of their disease.  

The Center for Medicare Services (CMS) has provided recommendations for regularly scheduled reassessment of these patients.

Specified protocols include:

Patients with established carotid disease should be monitored by NIVT as follows:
    20-39% stenosis - annually
    40-69% stenosis – every 6 months
    70-99% - as needed
    post carotid endarterectomy – when clinically necessary

Symptomatic patients should be assessed as needed to establish a diagnosis.

Headache or dizziness alone are not sufficient indications for noninvasive testing. True vertigo may be an indication.

In general, non-invasive studies of the arterial system can be utilized when invasive correction is contemplated, and to follow noninvasive medical treatment regimens to determine lesion regression.

Non-invasive studies can be useful in pre-operative evaluation of patients with known ASCVD who will be undergoing surgeries which put them at high risk for vascular complications.

Unfortunately, screening of asymptomatic patients (e.g. AAA) is not covered by Medicare.

Patients who have undergone interventions for critical carotid disease. The importance of contralateral disease has been emphasized. After CEA contralateral progression was more frequent than ipsilateral recurrent stenosis at long-term follow-up. Annual rates of progression were approximately two times that of ipsilateral disease. Baseline contralateral stenosis was a strong predictor of “progression to severe stenosis or occlusion”.

The only factor that appears to predict increased risk for future stroke is progression of stenosis.

Prophylactic carotid endarterectomy is warranted and should be offered to patients with an 80% stenosis.

The yield of duplex scanning after CEA was low. Only 5.9% developed disease severe enough to warrant intervention. During routine reassessment, progression of contralateral disease rather than restenosis was the most common abnormality that was identified. A policy of duplex scan surveillance and reoperation for high-grade stenosis was associated with a 1.6% incidence rate of disabling stroke during the follow-up period.

Duplex scanning at 1-year to 2-year intervals after CEA is adequate when a technically precise repair is achieved and minimal contralateral disease is identified.

If a patient has undergone a peripheral arterial intervention, we recommend follow-up as follows: 1st year: every 3 months, 2nd year every 6 months, third year and following every 12 months