PVD Follow-up Recommendations

Ongoing reassessment of patients with peripheral vascular disease is imperative given the progressive nature of the disease process. Although initial studies may have shown good flow characteristics and patent grafts, the natural course of the disease is one of recurrence with worsening stenosis and eventual vessel occlusion. This is particularly true for patients who not embraced recommended life-style modifications, particularly those who smoke, who are unable to modify their lipid profiles, or who are diabetics.

Recommended reassessment protocols include regular and focused questioning, physical examination, and ultrasound based investigations. Such reassessments should be made on a schedule determined at the time of intervention to ensure careful and precise follow-up designed to prevent vessel or graft closure. Clearly, if additional interventions are needed, they are far better performed before the graft or vessel occludes.

The Center for Medicare Services (CMS) has recommended duplex ultrasound follow-up studies for patients with cerebrovascular disease as follows: stenosis of 20-50% : annually, 50-79% : every six months, 80-99% : surgery recommended, and following surgery at 6 weeks, then at 6 months, and then annually. For patients with peripheral arterial disease who have undergone angioplasty or graft insertions (either autogenous or synthetic) follow-up studies are appropriate at three months intervals for the first year, six month intervals for the second year, and annually thereafter. (Screening of asymptomatic patients who have not undergone peripheral vascular interventions is not covered by Medicare). Reassessment of patients with venous disorders is indicated only when clinically indicated by the appearance of new symptoms or physical findings.

Because of the variability between vascular laboratories in both the diagnostic criteria used and in the technical conduct of the studies, follow-up reassessments are best performed in the same laboratory to ensure a constant standard of assessment and criteria for diagnosis. Additionally, the availability of previous studies allows comparison between new and previous studies.

We appreciate the opportunity to provide ongoing post-intervention assessments of peripheral vascular patients through the VUE (Vascular Ultrasound Evaluation) Center located in our office.