National report on optimal use of vascular
laboratory tests for patients with known or suspected arterial disease June 12, 2012 in Cardiology (Medical Xpress) -- A new
report issued today by the American College of Cardiology (ACC) and developed
in collaboration with 10 other leading professional societies provides detailed
criteria to help clinicians maximize the appropriate use of certain noninvasive
vascular tests when caring for patients with suspected or known non-coronary
arterial disorders. Emile R. Mohler, MD, professor of Medicine and director of
Vascular Medicine at Penn Medicine, chaired the national committee producing
the criteria. Failure Analysis Experts "This is the first
systematic and comprehensive evaluation looking at appropriate indications for
vascular testing, such as ultrasound or functional testing," said Dr.
Mohler, who is also a member of the Penn Medicine Cardiovascular Institute.
"We hope this document will help clinicians determine whether or not and
when to refer individual patients for testing." Ultrasound and other
noninvasive laboratory tests can be essential tools to help clinicians evaluate
vascular blockages and disease, for example, in the arteries of the neck,
kidneys, abdomen, and lower extremities, as well as the aorta itself. Such
testing also plays a central role in surveillance of the vascular system in
some patients to help inform treatment decisions and prevent serious problems,
and is part of follow-up after peripheral vascular procedures, such as arterial
bypass, surgical removal of plaque (endarterectomy), or stenting. Still, guidance
about when and how to best use this technology in practice is largely missing,
according to experts. Such decisions affect a growing number of patients as the
population ages. Dr. Mohler estimates more than 20 million adults in the U.S.
have some form of vascular disease, and would likely be a candidate for these
types of tests. The panel identified common clinical scenarios when noninvasive
vascular testing might be considered in patients with suspected or known
non-coronary arterial disorders (e.g., narrowing or blockages in the arteries
of the neck, kidneys, abdomen or legs, abdominal aortic aneurysms, arterial
dissection). Applying a rigorous rating scale, the 19-member panel then
assessed the appropriateness of each indication and often at different time
intervals (3-5, 6-8 and 9-12 months). In addition to looking at the reasons for
ordering these tests, the work group also sought to determine how frequently
repeat testing is needed in clinical practice in light of the need for ongoing
surveillance in some patients. The appropriate use criteria were developed in
collaboration with the ACC, American College of Radiology, American Institute
of Ultrasound in Medicine, American Society of Echocardiography, American
Society of Nephrology, Intersocietal Commission for the Accreditation of
Vascular Laboratories, Society for Cardiovascular Angiography and
Interventions, Society of Cardiovascular Computed Tomography, Society of
Interventional Radiology, Society for Vascular Medicine and Society for
Vascular Surgery. The document is further endorsed by the American Academy
of Neurology, American Podiatric Medical Association, Society for Clinical
Vascular Surgery, Society for Cardiovascular Magnetic Resonance, and Society
for Vascular Ultrasound.
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