Access-site hematoma, arterial dissection, thrombosis, and limb loss are known complications that can result from the procedure and occur in up to 2.0% of patients in this population [64]. These occur less frequently with increasing operator experience. For this document, it is assumed the procedure is performed and interpreted by an expert. Serious systemic complications are also possible, with increased risk in patients with severe widespread vascular disease, diabetes, renal insufficiency, or other contraindications to the use of iodinated contrast media. Carbon dioxide angiography may be of value in these patients. In light of the risk of nephrogenic systemic fibrosis in patients with severe renal disease, gadolinium chelates serve a very limited role as DSA contrast agents. Although DSA remains the gold standard for diagnosing PAD at the time of intervention, it generally plays no role in the surveillance of arterial segments previously treated with endovascular methods and in grafts without clinical evidence of malfunction. Discussion of Procedures by Variant Variant 1: Previous infrainguinal endovascular therapy or bypass. Asymptomatic. Surveillance. The most important indicator of restenosis or occlusion in the setting of previous revascularization is recurrence of symptoms. There is limited data to suggest that treatment of asymptomatic patients after endovascular therapy Lower Extremity Arterial Revascularization provides any long-term benefit [65]. As such, patients presenting to the clinic for follow-up of previous endovascular therapy or bypass for PAD should be evaluated for symptoms of claudication and rest pain, and should be examined closely for evidence of lower extremity ulceration or gangrene. ABI should be determined at each follow-up visit in all previously treated patients with PAD [66].
Lower Extremity Arterial Revascularization Post Therapy Imaging. Access-site hematoma, arterial dissection, thrombosis, and limb loss are known complications that can result from the procedure and occur in up to 2.0% of patients in this population [64]. These occur less frequently with increasing operator experience. For this document, it is assumed the procedure is performed and interpreted by an expert. Serious systemic complications are also possible, with increased risk in patients with severe widespread vascular disease, diabetes, renal insufficiency, or other contraindications to the use of iodinated contrast media. Carbon dioxide angiography may be of value in these patients. In light of the risk of nephrogenic systemic fibrosis in patients with severe renal disease, gadolinium chelates serve a very limited role as DSA contrast agents. Although DSA remains the gold standard for diagnosing PAD at the time of intervention, it generally plays no role in the surveillance of arterial segments previously treated with endovascular methods and in grafts without clinical evidence of malfunction. Discussion of Procedures by Variant Variant 1: Previous infrainguinal endovascular therapy or bypass. Asymptomatic. Surveillance. The most important indicator of restenosis or occlusion in the setting of previous revascularization is recurrence of symptoms. There is limited data to suggest that treatment of asymptomatic patients after endovascular therapy Lower Extremity Arterial Revascularization provides any long-term benefit [65]. As such, patients presenting to the clinic for follow-up of previous endovascular therapy or bypass for PAD should be evaluated for symptoms of claudication and rest pain, and should be examined closely for evidence of lower extremity ulceration or gangrene. ABI should be determined at each follow-up visit in all previously treated patients with PAD [66].