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

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

Research output: Contribution to journalReview articlepeer-review

5 Scopus citations


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.

Original languageEnglish
Pages (from-to)1176-1180
Number of pages5
JournalJournal of the American College of Radiology
Issue number12
StatePublished - Dec 2008


  • angioplasty
  • claudication
  • computed tomography angiography
  • magnetic resonance angiography
  • threatened limb


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