TY - JOUR
T1 - ACR Appropriateness Criteria® on Recurrent Symptoms Following Lower-Extremity Angioplasty
AU - Rybicki, Frank J.
AU - Nallamshetty, Leelakrishna
AU - Yucel, E. Kent
AU - Holtzman, Stephen R.
AU - Baum, Richard A.
AU - Foley, W. Dennis
AU - Ho, Vincent B.
AU - Mammen, Leena
AU - Narra, Vamsidhar R.
AU - Stein, Barry
AU - Moneta, Gregory L.
PY - 2008/12
Y1 - 2008/12
N2 - 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.
AB - 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.
KW - angioplasty
KW - claudication
KW - computed tomography angiography
KW - magnetic resonance angiography
KW - threatened limb
UR - http://www.scopus.com/inward/record.url?scp=56249114137&partnerID=8YFLogxK
U2 - 10.1016/j.jacr.2008.08.010
DO - 10.1016/j.jacr.2008.08.010
M3 - Review article
C2 - 19027679
AN - SCOPUS:56249114137
SN - 1546-1440
VL - 5
SP - 1176
EP - 1180
JO - Journal of the American College of Radiology
JF - Journal of the American College of Radiology
IS - 12
ER -