Management of Patients After Endovascular Interventions for Peripheral Artery Disease

Endovascular therapy to relieve intermittent claudication or critical limb ischemia in patients with lower-extremity peripheral artery disease is now firmly established as an alternative to surgical revascularization.1 The advent of novel technologies allows percutaneous interventions of increasingly complex arterial disease previously reserved for surgical interventions.2 Although the durability of aortoiliac interventions rivals that of surgical bypass, restenosis after femoropopliteal interventions remains the Achilles’ heel of endovascular therapies.Despite the growth of endovascular procedures, the optimal postprocedural care is not well established. Moreover, it is not clear how surveillance strategies influence health resource use and whether they can prolong the durability of vascular interventions and affect the patient’s cardiovascular health. The following recommendations are therefore extrapolated from clinical experience gained in medical and surgical management of patients with peripheral artery disease and patients undergoing percutaneous coronary interventions. In the absence of data derived from randomized, controlled trials, these recommendations necessarily reflect an interpretation of “best clinical practice” of an understudied clinical area. In this article, we attempt to outline a clinically sound strategy for long-term postprocedural care.Aggressive cardiovascular risk factor reduction is a key component of postprocedural care to prevent cardiovascular events in patients with peripheral artery disease such as myocardial infarction or stroke. Regular exercise should be an integral part of postprocedural care both because of its well-established clinical benefit and because it provides a gauge for detecting the progression of obstructive arterial disease. Formal exercise therapy is a potent treatment for claudication3 and may offer additional benefits after femoral artery revascularization.4 The details and justification for risk factor modification and regular exercise are discussed in published national guidelines.5–7Postprocedural care and surveillance also aim to optimize the durability of endovascular procedures by combining appropriate pharmacotherapy, periodic assessment of vessel patency, and …