ACR Appropriateness Criteria® on Recurrent Symptoms Following Lower-Extremity Angioplasty

Rybicki, Frank J.; Nallamshetty, Leelakrishna; Yucel, E. Kent; Holtzman, Stephen R.; Baum, Richard A.; Foley, W. Dennis; Ho, Vincent B.; Mammen, Leena; Narra, Vamsidhar R.; Stein, Barry; Moneta, Gregory L.

doi:10.1016/j.jacr.2008.08.010

« Previous Next »Journal of the American College of Radiology
Volume 5, Issue 12 , Pages 1176-1180, December 2008

ACR Appropriateness Criteria^® on Recurrent Symptoms Following Lower-Extremity Angioplasty

Frank J. Rybicki, MD, PhD
- Brigham and Women's Hospital, Boston, Massachusetts
- Corresponding author and reprints: Frank J. Rybicki, MD, PhD, Brigham and Women's Hospital, Department of Radiology, RA024, 75 Francis Street, Boston, MA 02115
Leelakrishna Nallamshetty, MD
- Brigham and Women's Hospital, Boston, Massachusetts
E. Kent Yucel, MD
- Tufts Medical Center, Boston, Massachusetts
Stephen R. Holtzman, MD
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
Richard A. Baum, MD
- Brigham and Women's Hospital, Boston, Massachusetts
W. Dennis Foley, MD
- Froedtert Hospital East, Milwaukee, Wisconsin
Vincent B. Ho, MD, MBA
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
- The opinions or assertions contained herein are the private views of the author and are not to be construed as official or reflecting the views of the Uniformed Services University of the Health Sciences or the US Department of Defense.
Leena Mammen, MD
- Advanced Radiology Services, Grand Rapids, Michigan
Vamsidhar R. Narra, MD
- Mallinckrodt Institute of Radiology, St. Louis, Missouri
Barry Stein, MD
- Jefferson X-Ray Group Inc., Hartford, Connecticut
Gregory L. Moneta, MD
- Oregon Health Science University, Portland, Oregon

Lower-extremity arteriopathy patients can be managed nonsurgically, but there is no standard algorithm for follow-up. The authors present a consensus on appropriate postangioplasty studies in the setting of claudication or a threatened limb. Physical examination with measurements of the ankle-brachial index should be the first step in patients with recurrent symptoms. When there is high clinical suspicion for a threatened limb, the patient should proceed directly to catheter angiography for possible reintervention. However, in the setting of claudication alone, segmental Doppler pressures and pulse volume recordings are the initial test of choice. Magnetic resonance angiography or ultrasound can be used in conjunction to further characterize lesions with more detail. Computed tomographic angiography may also be used to image lower-extremity vasculature but is limited by the presence of large amounts of vascular calcifications. Novel techniques, including dual-energy computed tomographic angiography and noncontrast magnetic resonance angiography, may provide clinicians with alternative approaches in patients with large amounts of vascular calcifications and renal insufficiency, respectively.

Key Words: Appropriateness Criteria^®, claudication, threatened limb, magnetic resonance angiography, computed tomography angiography, angioplasty