Peripheral Arterial Stent (Follow-Up)

Population Covered By The Guidance

This pathway provides diagnostic imaging guidance for follow-up of patients with peripheral arterial stents.

Lead Researcher: Sian Chin, Arjun Shivananda

Experts & Contributors: Ravinder Dhillon, Sieunarine Kishore, Phillip Misur, Patrice Mwipatayi, Paul Norman, Rachael O'Rourke, Carsten Ritter, Greg Van Schie

Editorial Panel: Core membership
Link to Editorial Panel

Date reviewed: January 2018

Date Published: June 2018

No available images

  • Doppler ultrasound following clinical assessment is the imaging modality of choice to follow-up patients with endovascular peripheral stents
  • Non-invasive angiography such as MRA and CTA has an increasing role in the assessment of lower limb peripheral arterial disease and pre procedural planning

Date of literature search: January 2018

References are graded from Level I to V according to the Oxford Centre for Evidence-Based Medicine, Levels of Evidence. Download the document

  1. Katsanos K, Tepe G, Tsetis D, Fanelli F. Standards of practice for superficial femoral and popliteal artery angioplasty and stenting. Cardiovasc Intervent Radiol. 2014;37(3):592-603. (Review article). View the reference
  2. Gerhard-Herman MD, Gornik HL, Barrett C, Barshes NR, Corriere MA, Drachman DE, et al. 2016 AHA/ACC guideline on the management of patients with lower extremity peripheral artery disease: a report of the American college of cardiology/American heart association task force on clinical practice guidelines. Circulation. 2017;135(12):e726-e79. (Guideline). View the reference
  3. Baril DT, Rhee RY, Kim J, Makaroun MS, Chaer RA, Marone LK. Duplex criteria for determination of in-stent stenosis after angioplasty and stenting of the superficial femoral artery. J Vasc Surg. 2009;49(1):133-9. (Level II evidence). View the reference
  4. Hirsch AT, Haskal ZJ, Hertzer NR, Bakal CW, Creager MA, Halperin JL, et al. ACC/AHA 2005 practice guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report. Circulation. 2006;113(11):463-654. (Guideline). View the reference
  5. Sobieszczyk P, Eisenhauer A. Management of patients after endovascular interventions for peripheral artery disease. Circulation. 2013;128(7):749-57. (Review article). View the reference
  6. Vroegindeweij D, Tielbeek AV, Buth J, Vos LD, van den Bosch HC. Patterns of recurrent disease after recanalization of femoropopliteal artery occlusions. Cardiovasc Intervent Radiol. 1997;20(4):257-62. (Level II evidence). View the reference
  7. Rybicki FJ, Nallamshetty L, Yucel EK, Holtzman SR, Baum RA, Foley WD, et al. ACR appropriateness criteria on recurrent symptoms following lower-extremity angioplasty. J Am Coll Radiol. 2008;5(12):1176-80. (Level II evidence). View the reference
  8. Conte MS, Pomposelli FB, Clair DG, Geraghty PJ, McKinsey JF, Mills JL, et al. Society for vascular surgery practice guidelines for atherosclerotic occlusive disease of the lower extremities: management of asymptomatic disease and claudication. J Vasc Surg. 2015;61(3 Suppl):2s-41s. (Guideline). View the reference
  9. Ho KJ, Owens CD. Diagnosis, classification, and treatment of femoropopliteal artery in-stent restenosis. J Vasc Surg. 2017;65(2):545-57. (Review article). View the reference
  10. Mohler ER, Gornik HL, Gerhard-Herman M, Misra S, Olin JW, Zierler RE. 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. J Vasc Surg. 2012;56(1):e17-51. (Guideline). View the reference
  11. Leiner T, Kessels AG, Nelemans PJ, Vasbinder GB, de Haan MW, Kitslaar PE, et al. Peripheral arterial disease: comparison of color duplex US and contrast-enhanced MR angiography for diagnosis. Radiology. 2005;235(2):699-708. (Level III evidence). View the reference
  12. Kawarada O, Higashimori A, Noguchi M, Waratani N, Yoshida M, Fujihara M, et al. Duplex criteria for in-stent restenosis in the superficial femoral artery. Catheter Cardiovasc Interv. 2013;81(4):E199-205. (Level III evidence). View the reference
  13. Kumamaru KK, Hoppel BE, Mather RT, Rybicki FJ. CT angiography: current technology and clinical use. Radiol Clin North Am. 2010;48(2):213-35. (Review article). View the reference
  14. Kock MC, Adriaensen ME, Pattynama PM, van Sambeek MR, van Urk H, Stijnen T, et al. DSA versus multi-detector row CT angiography in peripheral arterial disease: randomized controlled trial. Radiology. 2005;237(2):727-37. (Level I evidence). View the reference
  15. Kasapis C, Gurm HS. Current approach to the diagnosis and treatment of femoral-popliteal arterial disease. A systematic review. Current cardiology reviews. 2009;5(4):296-311. (Level II evidence). View the reference
  16. Collins R, Burch J, Cranny G, Aguiar-Ibanez R, Craig D, Wright K, et al. Duplex ultrasonography, magnetic resonance angiography, and computed tomography angiography for diagnosis and assessment of symptomatic, lower limb peripheral arterial disease: systematic review. BMJ. 2007;334(7606):1257. (Level I evidence). View the reference

Pathway User Guide

Yellow Boxes Denotes extra information. Some contain single or multiple white sub-boxes, click a white box to reveal detailed information in a pop-up.

White Boxes: Denotes standard pathway steps. (If inside a yellow box, they open a specific pop-up).

Zoom & Pan Controls: Use + / − or the slider to zoom. Reset returns to default. Tick Panning to drag the diagram when zoomed.

Blue “View Full Screen” Button: Opens the whole diagram in a large, full-screen pop-up window. Use Close to exit.

The relative radiation level (RRL) of each imaging investigation is displayed in the pop up box.

SYMBOL RRL EFFECTIVE DOSE RANGE
No radiation None 0
Minimal radiation Minimal < 1 millisieverts
Low radiation Low 1-5 mSv
Medium radiation Medium 5-10 mSv
High radiation High >10 mSv

Disclaimer

Status Of Recommendations Each pathway is designed to assist clinicians in situations when faced with a large array of possible diagnostic tests and examinations. However, it is recognised that diagnostic practice may differ from a particular pathway depending on local availability of equipment and expertise, as well as the experience of individual clinicians. Therefore each pathway is neither a rigid set of rules, nor a substitute for clinical assessment, and individual patient circumstances should always be considered.

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Cardiovascular