Postoperative Care/Surveillance


Given the challenges of post-op complications and the likelihood of wound recurrence in high-risk patients with lower extremity wounds and chronic limb-threatening ischemia, we have put together a brief list of pertinent references on post-op care and surveillance in this patient population. While this compendium is by no means exhaustive, it is our hope this guide offers resources from the literature on post-op considerations after endovascular procedures and the use of vein and prosthetic bypass grafts, as well as insights on offloading, skin temperature monitoring and ongoing use of the WIfI classification system to mitigate wound recurrence and prevent amputations.

Post-endovascular treatment

Rationale and benefits of surveillance after percutaneous transluminal angioplasty and stenting of iliac and femoral arteries.

Baril DT, Marone LK.In: AnuRahma AF, Bandyk DF, eds. Noninvasive Vascular Diagnosis: A Practical Guide to Therapy. Springer; 2013. P.339-46.

The natural history of duplex-detected stenosis after femoropopliteal endovascular therapy suggests questionable clinical utility of routine duplex surveillance.

Bui TD, Mills JL, Ihnat DM, Gruessner AC, Goshima KR, Hughes D.J Vasc Surg. 2012;55(2):346-52.
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Early duplex scanning after infrainguinal endovascular therapy.

Humphries MD, Pevec WC, Laird JR, Yeo KK, Hedayati N, Dawson DL.J Vasc Surg. 2011;53(2):353-8.
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Surveillance after peripheral artery angioplasty and stenting.

Armstrong PA, Bandyk DF. In: Zierler E, ed. Strandness’s Duplex Scanning in Vascular Disorders, 4th ed; Lippincott Williams & Wilkins: 2010. P.169-76.

The value of duplex surveillance after endovascular intervention for femoropopliteal obstructive disease.

Tielbeek AV, Rietjens E, Buth J, Vroegindeweij D, Schol FP.Eur J Vasc Endovasc Surg 1996;12(2):145-50.
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Postoperative care after vein and prosthetic bypass grafts

Systematic review and meta-analysis of duplex ultrasound surveillance for infrainguinal vein bypass grafts.

Abu Dabrh AM, Mohammed K, Farah W, et al.J Vasc Surg. 2017;66(6):1885-91.e8.
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Drug-eluting balloons and uncoated balloons perform equally to rescue infrainguinal autologous bypasses at risk.

Jongsma H, Akkersdijk GP, de Smet AAEA, Vroegindeweij D, de Vries JPPM, Fioole B.J Vasc Surg. 2017;66(2):454-460.
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ACCF/ACR/AIUM/ASE/ASN/ICAVL/SCAI/SCCT/SIR/SVM/SVS 2012 appropriate use criteria for peripheral vascular ultrasound and physiological testing part I: arterial ultrasound and physiological testing: a report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, American College of Radiology, American Institute of Ultrasound in Medicine, American Society of Echocardiography, American Society of Nephrology, Intersocietal Commission for the Accreditation of Vascular Laboratories, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Interventional Radiology, Society for Vascular Medicine, and Society for Vascular Surgery.

Mohler ER, Gornik HL, Gerhard-Herman M, Misra S, Olin JW, Zierler RE.J Vasc Surg. 2012;56(1):e17-51.
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Inter-society consensus for the management of peripheral arterial disease (TASC II).

Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FGR, TASC II Working Group.J Vasc Surg. 2007;45 Suppl S:S5-67.
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The relative importance of graft surveillance and warfarin therapy in infrainguinal prosthetic bypass failure.

Brumberg RS, Back MR, Armstrong PA, et al.J Vasc Surg. 2007;46(6):1160-6.
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Technical factors affecting autogenous vein graft failure observations from a large multicenter trial.

Schanzer A, Hevelone N, Owens CD, et al.J Vasc Surg. 2007;46(6):1180-90; discussion:1190.
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Prospective multicenter study of quality of life before and after lower extremity vein bypass in 1404 patients with critical limb ischemia.

Nguyen LL, Moneta GL, Conte MS, Bandyk DF, Clowes AW, Seely BL.J Vasc Surg. 2006;44(5):977-83; discussion 983-4.
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Is duplex surveillance of value after leg vein bypass grafting? Principal results of the Vein Graft Surveillance Randomised Trial (VGST).

Davies AH, Hawdon AJ, Sydes MR, Thompson SG.Circulation. 2005;112(13):1985-91.
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Infrainguinal vein bypass graft revision: factors affecting long-term outcome.

Nguyen LL, Conte MS, Menard MT, et al.J Vasc Surg. 2004;40(5):916-23.
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Long-term outcome of revised lower-extremity bypass grafts.

Landry GJ, Moneta GL, Taylor LM Jr, Edwards JM, Yeager RA, Porter JM.J Vasc Surg. 2002;35(1):56-62; discussion 62-3.
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The natural history of intermediate and critical vein graft stenosis: recommendations for continued surveillance or repair.

Mills JL Sr, Wixon CL, James DC, Devine J, Westerband A, Hughes JD.Ultrasound Med Biol. 2001;33(2):273-8; discussion 278-80.
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Post-op management of the limb after revascularization

Diabetic foot ulcers and their recurrence.

Armstrong DG, Boulton AJM, Bus SA.N Engl J Med 2017;376(24):2367-2375.
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Predictive ability of the Society for Vascular Surgery Wound, Ischemia, and foot Infection (WIfI) classification system after first-time lower extremity revascularizations.

Darling JD, McCallum JC, Soden PA, et al.J Vasc Surg. 2017;65(3):695-704.
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A systematic review and meta-analysis of off-loading methods for diabetic foot ulcers.

Elraiyah T, Prutsky G, Domecq JP, et al.J Vasc Surg. 2016;63(2 Suppl):59S-68S.e1-2.
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IWGDF guidance on footwear and offloading interventions to prevent and heal foot ulcers in patients with diabetes.

Bus SA, Armstrong DG, van Deursen RW, Lewis JEA, Caravaggi CF, Cavanagh PR, et al.Diabetes Metab Res Rev. 2016;32 Suppl 1:25-36.
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The Society of Vascular Surgery lower extremity threatened limb classification system based on wound, ischemia, and foot infection (WIfI) correlates with risk of major amputation and time to wound healing.

Zhan LX, Branco BC, Armstrong DG, Mills JL Sr.J Vasc Surg. 2015;61(4):939-44.
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Split-thickness skin grafting the high-risk diabetic foot.

Rose JF, Giovinco N, Mills JL, Najafi B, Pappalardo J, Armstrong DG.J Vasc Surg. 2014;59(6):1657-63.
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Prevention of recurrent foot ulcers with plantar pressure-based in-shoe orthoses: the CareFUL prevention multicenter randomized controlled trial.

Ulbrecht JS, Hurley T, Mauger DT, Cavanagh PR.Diabetes Care. 2014;37(7):1982-9.
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The Society for Vascular Surgery Lower Extremity Threatened Limb Classification System: risk stratification based on wound, ischemia, and foot infection.

Mills JL Sr, Conte MS, Armstrong DG, et al.J Vasc Surg. 2014;59(1):220-34.e1-2.
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An early validation of the Society for Vascular Surgery lower extremity threatened limb classification system.

Cull DL, Manos G, Hartley MC, et al.J Vasc Surg. 2014;60(6):1535-41.
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Juggling risk to reduce amputations: the three-ring circus of infection, ischemia and tissue loss-dominant conditions.

Armstrong DG, Mills JL.Wound Med. 2013;1:13-14.
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Diabetic foot disease: impact of ulcer location on ulcer healing.

Pickwell KM, Siersma VD, Kars M, Holstein PE, Schaper NC.Diabetes Metab Res Rev. 2013;29(5):377-83.
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Toe and flow: essential components and structure of the amputation prevention team.

Rogers LC, Andros G, Caporusso J, Harkless LB, Mills JL, Armstrong DG.J Vasc Surg. 2010;52(3 Suppl):23S-27S.
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Skin temperature monitoring reduces the risk for diabetic foot ulceration in high-risk patients.

Armstrong DG, Holtz-Neiderer K, Wendel C, Mohler MJ, Kimbriel HR, Lavery LA.Am J Med. 2007;120(12):1042-6.
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