ACR appropriateness criteria on recurrent symptoms following lower-extremity angioplasty.
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.
Rybicki
Frank J
FJ
Brigham and Women's Hospital, Boston, Massachusetts 02115, USA. frybicki@partners.org
Nallamshetty
Leelakrishna
L
Yucel
E Kent
EK
Holtzman
Stephen R
SR
Baum
Richard A
RA
Foley
W Dennis
WD
Ho
Vincent B
VB
Mammen
Leena
L
Narra
Vamsidhar R
VR
Stein
Barry
B
Moneta
Gregory L
GL
D017130:Angioplasty / Q000009:adverse effects* / Q000592:standards; D006801:Humans; D007383:Intermittent Claudication / Q000209:etiology* / Q000601:surgery*; D035002:Lower Extremity / Q000098:blood supply*; D017410:Practice Guidelines as Topic; D055502:Secondary Prevention; D014481:United States