Guidelines on peripheral arterial ultrasound and physiologic testing

New guidelines describe the appropriate uses of arterial ultrasound and physiological testing for patients with known or suspected peripheral vascular disorders.

The criteria, which were released by a collaboration of several medical societies and published by the Journal of the American College of Cardiology on June 11, described 255 clinical scenarios. Of these, 117 were judged to be appropriate uses of noninvasive vascular testing, 84 were rated as uncertain, and 54 were found to be inappropriate. The scenarios cover non-coronary arterial disorders including atherosclerotic occlusive disease (i.e., carotid artery stenosis, lower- and upper-extremity peripheral arterial disease, renal and mesenteric artery occlusive disease), abdominal aortic aneurysms, fibromuscular dysplasia, vasospasm, arterial dissection and arterial trauma.

In general, testing was found to be appropriate when indicated by clinical signs and symptoms, as well as to establish a baseline after revascularization. Follow-up studies for patients with normal findings were generally rated as inappropriate.

The criteria are intended to help clinicians maximize use of the noninvasive vascular laboratory, identify evidence gaps in the field, and serve as a reference for policymakers, the authors said, acknowledging that many potential indications for testing are not included. They noted that this document included more indications for surveillance than appropriate use criteria for other cardiovascular imaging modalities, because optimal clinical management of peripheral vascular disorders requires periodic imaging surveillance.

The criteria were titled “Part I,” and the authors wrote that appropriateness criteria for venous ultrasound and physiological testing are currently under development. The criteria were jointly released by the American College of Cardiology Foundation Appropriate Use Criteria Task Force, American College of Radiology, American Institute of Ultrasound in Medicine, American Society of Echocardiography, American Society of Nephrology, Intersocietal Commission for the Accreditation of Vascular Laboratories, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Interventional Radiology, Society for Vascular Medicine, Society for Vascular Surgery, American Academy of Neurology, American Podiatric Medical Association, Society for Clinical Vascular Surgery, Society for Cardiovascular Magnetic Resonance and Society for Vascular Ultrasound.