The Impact Of Clinical Follow-Up After Revascularization On The Outcomes Of Patients With Chronic Limb Threatening Ischemia

Objective: Guidelines for optimal follow-up for patients undergoing lower extremity revascularization (LER) for peripheral arterial disease (PAD) recommend multiple visits with imaging during the first year followed by yearly monitoring thereafter. Patients with chronic limb-threatening ischemia (CLTI) are at greater risk for mortality and major amputation than patients treated for claudication and thus necessitate closer monitoring. The goal of this paper is to study the effects of compliance with follow-up after revascularization for patients with CLTI on major amputation rates and mortality.Methods: A single-center retrospective chart review of consecutive patients undergoing LER for CLTI was performed. Patients were stratified based on compliance with follow-up to compliant or non-compliant cohorts. Patient characteristics, reinterventions, and perioperative and long-term outcomes were compared between the two groups. Results: There were 356 patients undergoing LER for CLTI and 61% (N=218) were compliant. There was no significant difference in baseline characteristics between the two groups. Non-compliant patients were more likely to undergo endovascular interventions compared to compliant patients (92.8% vs 79.4%, P=.03). There was no difference in perioperative outcomes between the 2 groups with overall 30-day mortality of 0.6%. After mean follow up of 2.7 years, compliant patients had greater ipsilateral reintervention rates (49.1% vs 34.1%, P=.005) as well as overall reintervention rates (61% vs 44.2%, P= 0.002) compared to non-compliant patients. There was no significant difference in mortality or ipsilateral major amputations between the 2 groups. Conclusions: Patients who were compliant with follow-up after LER for CLTI underwent more reinterventions with no difference in mortality or major amputation. Further research regarding the threshold for reintervention as well as the optimal schedule for follow up in patients with CLTI is needed