June 12th, 2012

ACC Releases Appropriate Use Criteria for Noninvasive Peripheral Vascular Tests

The American College of Cardiology (ACC) has published appropriate use criteria (AUC) for peripheral vascular ultrasound and physiological testing. The criteria were developed in coordination with 10 other medical societies.

“This is the first systematic and comprehensive evaluation looking at appropriate indications for vascular testing, such as ultrasound or functional testing,” said Emile Mohler III, the chair of the writing committee, in an ACC press release. “We hope this document will help clinicians determine whether or not and when to refer individual patients for testing.”

The 19 members of the panel identified common clinical situations in which noninvasive vascular testing is often considered and then assessed the appropriateness of each indication. In half of the scenarios, testing was deemed to be appropriate. In general, tests were considered appropriate when they were prompted by clinical signs and symptoms.

About 20% of scenarios were judged inappropriate. Here are examples cited by the ACC in the press release:

  • Ordering an ultrasound of the carotids or neck arteries in someone at low risk for heart attack or stroke.
  • Screening for kidney artery disease in someone with peripheral artery disease with well-controlled high blood pressure (hypertension) on one medication
  • Choosing to perform an abdominal ultrasound in a patient with nonspecific lower-extremity discomfort
  • Ordering a mesenteric artery ultrasound as an initial test to evaluate the patient with chronic constipation or diarrhea
  • Performing a follow-up study for a patient with a normal baseline study who has no new symptoms

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