News | July 09, 2012

New ACC Report Sheds Light on When to Order Vascular Laboratory Tests

ACC, other medical societies collaborate to provide guidance for appropriate use of vascular imaging and physiological testing across multiple indications

July 9, 2012 — A new report issued in June by the American College of Cardiology (ACC) and developed in collaboration with 10 other 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.

“This is the first systematic and comprehensive evaluation looking at appropriate indications for vascular testing, such as ultrasound or functional testing,” said Emile R. Mohler III, M.D., director of vascular medicine for the University of Pennsylvania Health System and chair of the writing committee. “We hope this document will help clinicians determine whether or not and when to refer individual patients for testing.”

Such decisions affect a growing number of patients as the population ages. Mohler estimates more than 20 million adults in the United States have some form of vascular disease, and would likely be a candidate for these types of tests.

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.

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).

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, 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.

One-third of the indications were rated as “uncertain.” According to Mohler, these indications represent variations in practice and reveal important gaps in the evidence, prompting the panel to call for clinical and cost-effectiveness studies on non-invasive vascular testing. Notably, the panel determined one in five uses of vascular testing to be “inappropriate,” meaning that, although doing the test does not cause harm, the information gleaned would not further inform clinical judgment. A few examples include:

  • Ordering an ultrasound of the carotids 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; and
  • Performing a follow-up study for a patient with a normal baseline study who has no new symptoms.


“As imaging technology and clinical applications continue to advance, the healthcare community needs to understand how to best incorporate these technologies into daily clinical care,” said Mohler. “These appropriate use criteria should guide clinicians as to what is an appropriate and inappropriate test so that we can rationally decide when testing is the best next step, especially in this time of cost-effectiveness in medicine.”

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.

Mohler stresses these criteria should not supersede sound clinical judgment for individual patients. The document also outlines key research areas moving forward. A related report presenting appropriate use criteria for vascular laboratory testing to evaluate venous circulation is expected to be released in late fall 2012.

For more information: www.cardiosource.org/ACC

Related Content

Fujifilm Exhibits Enterprise Imaging Solutions and Artificial Intelligence Initiative at HIMSS 2019
News | Enterprise Imaging | February 15, 2019
Fujifilm Medical Systems U.S.A. Inc. and Fujifilm SonoSite Inc. showcased their enterprise imaging and informatics...
Philips Launches Latest Iteration of IntelliSpace Cardiovascular at HIMSS 2019
Technology | Cardiac PACS | February 13, 2019
Philips announced the launch of IntelliSpace Cardiovascular 4.1, its next-generation cardiovascular image and...
Micro-Ultrasound and Artificial Intelligence Combining to Detect Prostate Cancer
News | Prostate Cancer | February 12, 2019
Cambridge Consultants has partnered with Exact Imaging, makers of the ExactVu micro-ultrasound platform, as the two...
An example of Philips' TrueVue technology, which offers photo-realistic rendering and the ability to change the location of the lighting source on 3-D ultrasound images. In this example of two Amplazer transcatheter septal occluder devices in the heart, the operator demonstrating the product was able to push the lighting source behind the devices into the other chamber of the heart. This illuminated a hole that was still present that the occluders did not seal.

An example of Philips' TrueVue technology, which offers photo-realistic rendering and the ability to change the location of the lighting source on 3-D ultrasound images. In this example of two Amplazer transcatheter septal occluder devices in the heart, the operator demonstrating the product was able to push the lighting source behind the devices into the other chamber of the heart. This illuminated a hole that was still present that the occluders did not seal. 

Feature | Ultrasound Imaging | February 07, 2019 | Dave Fornell, Editor
Here is a list of six key trends in ul...
Epiq Elite for Obstetrics and Gynecology delivers high image quality and lifelike 3-D scans

The Epiq Elite for Obstetrics & Gynecology. Image courtesy of Philips Healthcare.

Technology | Ultrasound Imaging | February 07, 2019
Philips announced the launch of the Epiq Elite ultrasound system, a new premium ultrasound that combines the latest...
ASE Releases Guidelines for Transesophageal Echo in Congenital Heart Disease
News | Ultrasound Transesophageal echo (TEE) | February 05, 2019
February 5, 2019 – The American Society of Echocardiography (ASE) released a new document that provides a comprehensi
Konica Minolta Releases Sonimage HS1 Ultrasound Software Upgrade
News | Ultrasound Imaging | January 31, 2019
Konica Minolta Healthcare Americas Inc. released a new software upgrade for the Sonimage HS1 Ultrasound System that...
QTbreasthealth Opens New Breast Ultrasound Imaging Center in Grand Rapids
News | Ultrasound Women's Health | January 30, 2019
January 30, 2019 — QTbreasthealth launched a center in Grand Rapids, Mich., featuring its quantitative transmission
ASE Releases New Guide to Performing Comprehensive Transthoracic Echo Exams
News | Cardiovascular Ultrasound | January 21, 2019
January 21, 2019 – Medical experts have released “...
Triton College Launching Vascular Technology in Sonography Certificate Program
News | Ultrasound Imaging | January 09, 2019
Starting in spring 2019, Triton College’s Vascular Technology in Sonography Certificate Program will help working...