Guidelines Established by American College of Cardiology for Appropriate Use of Ultrasound for Peripheral Vascular Testing
As reimbursement cuts continue to be made, determining if and when a diagnostic test is necessary is becoming more prevalent. The American College of Cardiology (ACC) collaborated with 10 other medical organizations to develop a set of guidelines to assist clinicians with their decision making process for diagnostic testing. The group focused on determining testing appropriateness for vascular ultrasound and functional testing for patients with suspected or known non-coronary arterial disorders.
Ultrasound is a cost-effective diagnostic tool that provides information to physicians needing to evaluate vascular blockages and disease in areas such as arteries of the neck, kidneys, abdomen, and lower extremities. In addition to be used as a screening measure, ultrasound is also used for determining the status post peripheral vascular procedures, such as arterial bypass, surgical removal of plaque (endarterectomy), or stenting.
The panel also looked at areas where testing would not be useful and found that one in five uses of vascular testing were deemed to be "inappropriate". Some examples are:
The team used a rating scale coupled with timeframe intervals. According to the press release "The group found arterial vascular testing to be "appropriate" in about half of the clinical situations evaluated. Overall, vascular studies were deemed appropriate when clinical signs and symptoms were the main reason for testing. For example, Dr. Mohler explains it is reasonable to order a lower extremity vascular study for a patient who reports calf pain upon walking that resolves with rest. Tests that were conducted in patients with existing atherosclerotic disease or to establish a "baseline" after a revascularization procedure were also considered appropriate based on ratings."
- Ordering an ultrasound of the carotids or neck arteries in someone at low risk for heart attack or stroke.
- Screening for kidney artery disease in someone with peripheral artery disease with well controlled high blood pressure (hypertension) on one medication
- Choosing to perform an abdominal ultrasound in a patient with non-specific lower extremity discomfort
- Ordering a mesenteric artery ultrasound (arteries that supply the small and large intestines) as an initial test to evaluate the patient with chronic constipation or diarrhea
- Having current ultrasound technology in a clinician's facility is essential for careful diagnosis. To learn more about our recommended Toshiba Viamo portable ultrasound machine for vascular procedures, click here.