Synopsis
Build a repair-specific surveillance plan that detects clinical deterioration, conduit or device failure and disease progression while reinforcing secondary prevention, functional recovery and timely re-intervention.
- New ischaemic, bleeding, infective or rupture symptoms bypass routine follow-up: arrange urgent vascular assessment and targeted duplex or CTA rather than waiting for the scheduled surveillance test.
- After lower-limb revascularisation for intermittent claudication, combine symptoms, wound and pulse examination, ankle or toe pressures and risk-factor review; add duplex for autologous vein grafts and below-knee interventions because clinically silent stenosis can precede occlusion.
- After standard EVAR with a device of proven durability, obtain CTA within 30 days. Low-frequency imaging during the first five years requires no endoleak or compromised seal, anatomy within the device instructions for use, adequate component overlap, at least 10 mm proximal and distal seal, neck diameter no greater than 30 mm, neck angulation no greater than 60°, iliac diameter no greater than 20 mm and no investigational or new device; non-standard and complex EVAR need individualised follow-up, and every EVAR patient needs long-term imaging regardless of initial risk.
Key red flags
Sudden loss of a previously palpable pulse, falling ankle pressure, rest pain or neurological deficit suggests graft or stent thrombosis and acute limb ischaemia.
New abdominal or back pain, hypotension, sac enlargement, a pulsatile mass or gastrointestinal bleeding after aortic repair suggests rupture, endoleak, pseudoaneurysm or fistulation.
Fever, recurrent bacteraemia, wound breakdown, perigraft pain or a draining sinus suggests graft infection and requires cultures plus urgent graft-focused imaging.
A non-healing wound, recurrent claudication or progressive tissue loss despite patent proximal reconstruction may indicate inflow, conduit, outflow or microcirculatory failure.
New fever, graft pain, wound change, pulsatile mass or bleeding requires urgent assessment for graft infection and pseudoaneurysm rather than routine patency review.
Reasoning priorities
Establish whether perfusion, tissue healing, symptoms and cardiovascular prevention are improving from the postoperative baseline.
New rest pain, tissue loss, pulse change or reproducible pressure decline prompts anatomical imaging; incompressible ankle arteries require toe pressure or another validated perfusion measure.
Worked reasoning
After bypass for intermittent claudication, the operative wound is healed and walking symptoms improved, but the graft remains within the early surveillance period.
- Context: confirm the original indication, target vessel, conduit and postoperative baseline; ask about recurrent claudication, rest pain, wound progress and cardiovascular or bleeding events.
- Reasoning: examine the limb and conduit, compare ankle or toe pressure with baseline and perform duplex because a palpable pulse and symptomatic improvement do not exclude a clinically silent graft stenosis.
- Action: if duplex shows a haemodynamically important correctable stenosis, review inflow, outflow and technical anatomy promptly with the vascular team rather than waiting for graft thrombosis.
- Verification: after observation or intervention, document symptoms, wound, pressures and duplex result, then continue surveillance and secondary prevention through the period when graft failure is concentrated.
The patient is clinically stable after standard EVAR with a proven device, and early CTA is available to classify device, seal, endoleak, morphology and sac risk.