Duplex ultrasound surveillance after femoropopliteal endovascular treatment for peripheral arterial disease: a systematic review and narrative synthesis

Abstract

ObjectiveTo review the current literature and establish a consensual recommendation on duplex ultrasound (DUS) surveillance after endovascular treatment of the femoropopliteal tract. MethodsThis systematic review conducted literature searches on DUS surveillance after endovascular treatment of the femoropopliteal tract, and event rates. The primary end point was primary assisted patency. Secondary end points were primary patency, secondary patency, and limb salvage for double-armed studies, and sensitivity and specificity of DUS compared with other surveillance methods for single-armed studies. PubMed, Embase, and the Cochrane Library were searched. A systematic review was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement. Articles were eligible if they compared DUS surveillance others surveillance methods. Prospective, large cohort studies reporting on long-term events after endovascular treatment were also included. ResultsThe initial search resulted in five studies. Only one double-armed non-randomized study compared DUS surveillance with ankle-brachial index (ABI) follow-up after femoropopliteal stenting. The DUS group demonstrated improved primary assisted patency (84% versus 76% at 12 months and 68% versus 38% at 36 months, p=.008) and limb salvage (97% versus 83% at 12 months and 90% versus 50% at 36 months, p<.001) compared with ABI follow-up. In one single-armed study, DUS surveillance showed a high sensitivity (91%) and specificity (100%) in detecting restenosis. ABI and clinical follow-up demonstrated a low sensitivity (55%-67% and 52%-64%, respectively) but reasonable specificity (80%-85% and 82%-88%, respectively) in detecting restenosis. ConclusionThe scarce available evidence suggests a clinical benefit of DUS surveillance after endovascular treatment of the femoropopliteal tract.