ACR Appropriateness Criteria ® Lower Extremity Arterial Revascularization—Post-Therapy Imaging

Abstract

Peripheral arterial disease (PAD) affects millions across the world and in the United States between 9% to 23% of all patients older than 55 years. The refinement of surgical techniques and evolution of endovascular approaches have improved the success rates of revascularization in patients afflicted by lower extremity PAD. However, restenosis or occlusion of previously treated vessels remains a pervasive issue in the postoperative setting. A variety of different imaging options are available to evaluate patients and are reviewed within the context of asymptomatic and symptomatic patients with PAD who have previously undergone endovascular or surgical revascularization. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

ACR Appropriateness Criteria® Nonatherosclerotic Peripheral Arterial Disease

“…Varicose veins and deep vein thrombosis are common venous diseases of the lower extremities, with deep vein thrombosis having an estimated annual incidence of 5 per 10,000 in the general population [11]. Guidelines addressing lower-extremity atherosclerotic vascular disease and deep vein thrombosis have been addressed in previously published ACR Appropriateness Criteria Ò : "Vascular Claudication-Assessment for Revascularization" [12], "Lower Extremity Arterial Revascularization-Post-Therapy Imaging" [13], "Sudden Onset of Cold, Painful Leg" [14], and "Suspected Lower Extremity Deep Vein Thrombosis" [11].…”

2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS Guideline for the Management of Lower Extremity Peripheral Artery Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines

“…Multisocietal appropriate use criteria for vascular testing have been published that include criteria for surveillance after endovascular and surgical revascularization. 17,20 In 2018, the Society for Vascular Surgery published practice guidelines for follow-up after vascular surgery arterial procedures based on observational studies, committee consensus, and indirect evidence. 14 These guidelines address surveillance after endovascular and surgical revascularization and by arterial segment.…”

Cutaneous Microcirculation of the Foot

“…Apart from the above techniques, transcutaneous oxygen measurement (tcpO2) is a simple, non-invasive method that allows the assessment of the amount of oxygen that diffuses from the capillaries through the epidermis to the electrode and thus provides an estimate of the functional ability of the microvessels to deliver oxygen to the tissue and understand the ischaemic status [58]. Measurement of TcPO2 allows the determination of tissue oxygen tension and can help understand tissue perfusion as it can be performed in people with arterial calcification and no pedal pulse [59,60]. Therefore, TcPO2 measurement can be useful in evaluating wound healing, especially in people with ulcers in relation to diabetic foot disease [58].…”