SlideShare ist ein Scribd-Unternehmen logo
1 von 23
Appropriate Arterial Testing
By: Hollie Peterson
Created in response to increased effort to rationally use imaging
services
Ensure high-quality care
Diagnostic imaging services Medicare reimbursement grew more
rapidly than any other physician service from 1999 to 2003
American College of Cardiology Foundation (ACCF) partnered with
specialty + subspecialty societies to review common clinical
scenarios
Appropriate Use Criteria Continued…
255 Clinical Scenarios (indications) scored on scale 1 to 9
Appropriate (7 to 9)
177 indications
Uncertain “Gray Zone” (4 to 6)
84 indications
Inappropriate (1 to 3)
54 indications
This effort has potential to impact physician decision making,
healthcare delivery, & reimbursement policy
Scenarios were evaluated for 8 different arterial tests
Types of Arterial Exams
Extracranial Cerebrovascular Duplex
Carotid Duplex Screening
Renal & Mesenteric Artery Duplex
Aortic & Aortoiliac Duplex
LE Artery Testing (Multilevel Physiological Testing Alone
or Duplex Ultrasound with Single-Level ABI & PVR)
LE Artery Testing with ABI only
LE Artery with Duplex only
UE Arterial Testing (Physiological Testing or Duplex
Ultrasound)
Extracranial Cerebrovascular
Duplex Ultrasound
What is it?
Ultrasound study done to assess blood flow of carotid and
vertebral arteries outside the skull
Appropriate
 Neurological symptoms
 Suspected vertebrobasilar symptoms (present circulation
symptoms)
 Evaluation of TIA or stroke
Inappropriate
 Carotid Artery Stenosis Surveillance (mild to moderate)
“Gray Zone”
 Prior to open heart surgery
 Syncope symptoms
Carotid Duplex Screening
What is it?
Limited ultrasound study done to assess blood flow of arteries
that supply blood from heart up through the neck into the brain
Appropriate
 Dissection arising from aortic arch into arch vessels (CCA)
 Inner lining tears allowing blood to flow into a “false
lumen”
Inappropriate
 Trauma induced dissection
 Normal baseline carotid follow-up
 Repeat studies for moderate ICA lesions within first year
 Low to moderate Framingham risk score
 Risk of having heart attack in the next 10 years
“Gray Zone”
 Surveillance beyond first year (normal carotid stenosis)
 Intermediate to high Framingham risk score
Renal & Mesenteric Artery
Duplex
What is it?
Renal Duplex: Ultrasound study done to evaluate the renal
arteries that feed the kidneys.
Mesenteric Duplex: Ultrasound study done to evaluate the
arteries supplying blood flow to organs involved with digestion.
Renal Mesenteric
 Appropriate
 HTN
 Creatinine (elevated)
 Heart failure
 Inappropriate
 PAD
 “Gray Zone”
 Enlarged Kidney
 Appropriate
 Postprandial (after
dinner/lunch) pain
 Weight loss
 GI evaluation completed
 Inappropriate
 Incomplete GI exam
 Acute abdominal pain
 “Gray Zone”
 Abdominal bruit
Aortic & Aortoiliac Duplex
What is it?
Ultrasound study performed to evaluate the aorta (the main
artery in the abdomen) and surrounding arteries that
deliver blood to major organs in the body.
Appropriate
 Intermittent claudication
 Aneurysmal femoral/Popliteal Pulse
 Abdominal/femoral bruit
Inappropriate
 LE discomfort
 Fever
 LE swelling
 HTN
“Gray Zone”
 Erectile Dysfunction
LE Artery Testing:
Multi-level Physiological Testing Alone or Duplex
Ultrasound with Single-level ABI & PVR
What is it?
Multi-level Physiological Testing: Segmental Pressures are taken
from the ankle up to the thigh (3 cuffs or 4 cuffs) to determine if
pressure differences exist (>30 mmHg)
Single Level: Ankle Brachial Index (ABI) is found by dividing
highest arm pressure by highest ankle pressure. Pulse Volume
Recording (PVR) is used to measure volume changes in limb
pressures from the thigh down to the ankle.
Appropriate
 LE Claudication, rest pain
 Ulcers, gangrene, ischemia
 Normal/Abnormal ABI (new or worsening symptoms)
Inappropriate
 Symptoms present along with normal pulses
 Ex. Nocturnal leg cramps, neuropathy, LE swelling
or hair loss
LE Artery Testing:
ABI only
What is it?
Physiological test done to determine the ratio of ankle systolic
pressure to arm systolic pressure, which the numerical index
serving as an indicator of arterial insufficiency (Normal= > 1.0)
Appropriate
 Diminished pulses
 Femoral Bruit
 >50 years old with diabetes or smoking
“Gray Zone”
 <50 years old with diabetes
LE Artery Testing:
Duplex only
What is it?
Ultrasound study performed to evaluate the arteries of the legs
in order to identify narrowing of vessels.
Appropriate
 Groin symptoms
o Ex. Pulsatile mass, Bruit or thrill, severe pain post-
procedure
 Significant hematoma
(solid swell of blood in tissues)
“Gray Zone”
 Ecchymosis
(Discoloration of skin resulting from bleeding underneath)
UE Arterial Testing:
Physiological Test or Duplex Ultrasound
What is it?
Physiological: segmental pressures are taken in the upper
extremity arteries to determine presence, severity, and
location of arterial occlusive disease
Duplex: Ultrasound study performed to evaluate the arteries
of the arms in order to identify narrowing of vessels.
Appropriate
 Claudication, ulceration, ischemia, bruit
 Unilateral cold painful hand
 UE trauma due to vascular harvest
“Gray Zone”
 Raynaud’s phenomenon
 Vasospastic disorder
 >20 mmHg brachial pressure difference
 Periclavicular (around the clavicle) bruit
 A 72 year old male complains of rest pain symptoms. He is
diabetic and has smoked 2 packs per day for 50 years.
 LE Arterial Testing with ABI only
 A 75 yr old woman presents with temporal headaches.
Additionally, she complains of muscle aching in shoulders +
arm fatigue with physical activity.
 UE Arterial Physiological Test (segmental pressures) +
Duplex (if pressure difference is found)
Patient Example
Policy Recommendations:
Cost Effective Research
Educate students
Education seminar for physicians
References
• https://bb.clemson.edu/bbcswebdav/pid-2583164-dt-content-rid-
23095847_2/courses/faltad-
HLTH4180/AUC%20for%20Extracranial%20and%20Arterial%20Testing-ACC.pdf

Weitere ähnliche Inhalte

Was ist angesagt?

Improving maximum walking distance in early peripheral arterial disease
Improving maximum walking distance in early peripheral arterial disease Improving maximum walking distance in early peripheral arterial disease
Improving maximum walking distance in early peripheral arterial disease
Shilpa Prajapati
 
Buerger’s disease
Buerger’s diseaseBuerger’s disease
Buerger’s disease
Rakshith AVB
 

Was ist angesagt? (20)

Diagnostic guidelines for peripheral arterial disease
Diagnostic guidelines for peripheral arterial diseaseDiagnostic guidelines for peripheral arterial disease
Diagnostic guidelines for peripheral arterial disease
 
Peripheral arterial disease
Peripheral arterial diseasePeripheral arterial disease
Peripheral arterial disease
 
Peripheral vascular disease
Peripheral vascular diseasePeripheral vascular disease
Peripheral vascular disease
 
Patient with a toe gangrene coming to Emergency Department CSSL2021
Patient with a toe gangrene coming to Emergency Department CSSL2021Patient with a toe gangrene coming to Emergency Department CSSL2021
Patient with a toe gangrene coming to Emergency Department CSSL2021
 
occlusive arterial disease
occlusive arterial diseaseocclusive arterial disease
occlusive arterial disease
 
Occlusive arterial disease 2019
Occlusive arterial disease 2019Occlusive arterial disease 2019
Occlusive arterial disease 2019
 
Improving maximum walking distance in early peripheral arterial disease
Improving maximum walking distance in early peripheral arterial disease Improving maximum walking distance in early peripheral arterial disease
Improving maximum walking distance in early peripheral arterial disease
 
Henao
HenaoHenao
Henao
 
Peripheral vascular disease and Clinical features of acute and chronic arteri...
Peripheral vascular disease and Clinical features of acute and chronic arteri...Peripheral vascular disease and Clinical features of acute and chronic arteri...
Peripheral vascular disease and Clinical features of acute and chronic arteri...
 
peripheral vascular disease
peripheral vascular diseaseperipheral vascular disease
peripheral vascular disease
 
Amol gulhane -peripheral vascular disease
Amol gulhane -peripheral vascular diseaseAmol gulhane -peripheral vascular disease
Amol gulhane -peripheral vascular disease
 
PAD & Lower Extremity Interventions
PAD & Lower Extremity InterventionsPAD & Lower Extremity Interventions
PAD & Lower Extremity Interventions
 
Treatment Choices for Peripheral Artery Disease
Treatment Choices for Peripheral Artery DiseaseTreatment Choices for Peripheral Artery Disease
Treatment Choices for Peripheral Artery Disease
 
Scigmoid know your heart
Scigmoid know your heartScigmoid know your heart
Scigmoid know your heart
 
Chronic venous disease 2020
Chronic venous disease 2020Chronic venous disease 2020
Chronic venous disease 2020
 
Buerger’s disease
Buerger’s diseaseBuerger’s disease
Buerger’s disease
 
Blood coagulation
Blood coagulationBlood coagulation
Blood coagulation
 
CHRONIC PERIPHERAL ARTERIAL OCCLUSIVE DISEASE
CHRONIC PERIPHERAL ARTERIAL OCCLUSIVE DISEASECHRONIC PERIPHERAL ARTERIAL OCCLUSIVE DISEASE
CHRONIC PERIPHERAL ARTERIAL OCCLUSIVE DISEASE
 
Peripheral arterial diseases
Peripheral arterial diseasesPeripheral arterial diseases
Peripheral arterial diseases
 
peripherial arterial disease
peripherial arterial diseaseperipherial arterial disease
peripherial arterial disease
 

Andere mochten auch

Oldschool Bodybuilding
Oldschool BodybuildingOldschool Bodybuilding
Oldschool Bodybuilding
kayleyeisenb
 

Andere mochten auch (13)

Oldschool Bodybuilding
Oldschool BodybuildingOldschool Bodybuilding
Oldschool Bodybuilding
 
Mobile Development for Devices and IoT
Mobile Development for Devices and IoTMobile Development for Devices and IoT
Mobile Development for Devices and IoT
 
15 swift 클래스
15 swift 클래스15 swift 클래스
15 swift 클래스
 
A testi jellemzők és a testtartás
A testi jellemzők és a testtartásA testi jellemzők és a testtartás
A testi jellemzők és a testtartás
 
My eyes your eyes
My eyes your eyesMy eyes your eyes
My eyes your eyes
 
2552
25522552
2552
 
Condom catheter with a draining channel
Condom catheter with a draining channelCondom catheter with a draining channel
Condom catheter with a draining channel
 
UH Energi Dalam Sitem Kehidupan
UH Energi Dalam Sitem KehidupanUH Energi Dalam Sitem Kehidupan
UH Energi Dalam Sitem Kehidupan
 
Irsyadul Amir. Pelatihan Advokasi Mahasiswa dan Gerakan Sosial (Aksi Aktivis ...
Irsyadul Amir. Pelatihan Advokasi Mahasiswa dan Gerakan Sosial (Aksi Aktivis ...Irsyadul Amir. Pelatihan Advokasi Mahasiswa dan Gerakan Sosial (Aksi Aktivis ...
Irsyadul Amir. Pelatihan Advokasi Mahasiswa dan Gerakan Sosial (Aksi Aktivis ...
 
Sasawat subhem 13
Sasawat subhem 13Sasawat subhem 13
Sasawat subhem 13
 
ENZCON_BPSRx_3
ENZCON_BPSRx_3ENZCON_BPSRx_3
ENZCON_BPSRx_3
 
ADHOC Presentation
ADHOC PresentationADHOC Presentation
ADHOC Presentation
 
Quit Smoking for Good
Quit Smoking for GoodQuit Smoking for Good
Quit Smoking for Good
 

Ähnlich wie Appropriate Arterial Testing

The heart systolic murmur
The heart systolic murmurThe heart systolic murmur
The heart systolic murmur
Dalal Alanazi
 
Vascular Laboratory: Arterial Physiologic Assessment & Arterial Duplex Scanning
Vascular Laboratory: Arterial Physiologic Assessment & Arterial Duplex ScanningVascular Laboratory: Arterial Physiologic Assessment & Arterial Duplex Scanning
Vascular Laboratory: Arterial Physiologic Assessment & Arterial Duplex Scanning
Tapish Sahu
 
General Physical Assessment
General Physical AssessmentGeneral Physical Assessment
General Physical Assessment
calvin123
 
Kin 191 B – Abdomen And Thorax Anatomy And Evaluation
Kin 191 B – Abdomen And Thorax Anatomy And EvaluationKin 191 B – Abdomen And Thorax Anatomy And Evaluation
Kin 191 B – Abdomen And Thorax Anatomy And Evaluation
JLS10
 
Emergency Ultrasound In Trauma
Emergency Ultrasound In TraumaEmergency Ultrasound In Trauma
Emergency Ultrasound In Trauma
u.surgery
 
upper G I Bleed (non variceal)
upper G I Bleed (non variceal)upper G I Bleed (non variceal)
upper G I Bleed (non variceal)
Juned Khan
 
GI Bleeding
GI BleedingGI Bleeding
GI Bleeding
alone
 

Ähnlich wie Appropriate Arterial Testing (20)

Cardiac Anatomy and Physiology
Cardiac Anatomy and PhysiologyCardiac Anatomy and Physiology
Cardiac Anatomy and Physiology
 
Vascular Examinaton
Vascular ExaminatonVascular Examinaton
Vascular Examinaton
 
Vascular Examination
Vascular ExaminationVascular Examination
Vascular Examination
 
Cardiac assessment
Cardiac assessmentCardiac assessment
Cardiac assessment
 
Cardiac failure pres
Cardiac failure presCardiac failure pres
Cardiac failure pres
 
Embolic and thromboembolic diseases
Embolic and thromboembolic diseasesEmbolic and thromboembolic diseases
Embolic and thromboembolic diseases
 
The heart systolic murmur
The heart systolic murmurThe heart systolic murmur
The heart systolic murmur
 
Appraoch to child with hip pain
Appraoch to child with hip painAppraoch to child with hip pain
Appraoch to child with hip pain
 
Vascular Laboratory: Arterial Physiologic Assessment & Arterial Duplex Scanning
Vascular Laboratory: Arterial Physiologic Assessment & Arterial Duplex ScanningVascular Laboratory: Arterial Physiologic Assessment & Arterial Duplex Scanning
Vascular Laboratory: Arterial Physiologic Assessment & Arterial Duplex Scanning
 
Approach to a patient with chest pain
Approach to a patient with chest painApproach to a patient with chest pain
Approach to a patient with chest pain
 
General Physical Assessment
General Physical AssessmentGeneral Physical Assessment
General Physical Assessment
 
Kin 191 B – Abdomen And Thorax Anatomy And Evaluation
Kin 191 B – Abdomen And Thorax Anatomy And EvaluationKin 191 B – Abdomen And Thorax Anatomy And Evaluation
Kin 191 B – Abdomen And Thorax Anatomy And Evaluation
 
Approach to Chest Pain
Approach to Chest PainApproach to Chest Pain
Approach to Chest Pain
 
CHEST PAIN.pptx
CHEST PAIN.pptxCHEST PAIN.pptx
CHEST PAIN.pptx
 
Emergency Ultrasound In Trauma
Emergency Ultrasound In TraumaEmergency Ultrasound In Trauma
Emergency Ultrasound In Trauma
 
upper G I Bleed (non variceal)
upper G I Bleed (non variceal)upper G I Bleed (non variceal)
upper G I Bleed (non variceal)
 
GI Bleeding
GI BleedingGI Bleeding
GI Bleeding
 
Examining the Acute Abdomen
Examining the Acute AbdomenExamining the Acute Abdomen
Examining the Acute Abdomen
 
CHRONIC LIVER DISEASE Case Presentation
CHRONIC LIVER DISEASE Case PresentationCHRONIC LIVER DISEASE Case Presentation
CHRONIC LIVER DISEASE Case Presentation
 
Chest Pain.ppt
Chest Pain.pptChest Pain.ppt
Chest Pain.ppt
 

Mehr von Hollie Peterson (9)

GHS Oncology Inpatient Guide 4.25.17
GHS Oncology Inpatient Guide 4.25.17GHS Oncology Inpatient Guide 4.25.17
GHS Oncology Inpatient Guide 4.25.17
 
GHS Educational downloads
GHS Educational downloadsGHS Educational downloads
GHS Educational downloads
 
Intern Final Reflection
Intern Final ReflectionIntern Final Reflection
Intern Final Reflection
 
Hollie C. Peterson Resume
Hollie C. Peterson ResumeHollie C. Peterson Resume
Hollie C. Peterson Resume
 
Professional Societies
Professional Societies Professional Societies
Professional Societies
 
Accrediting Organizations
Accrediting Organizations Accrediting Organizations
Accrediting Organizations
 
Hollie C. Peterson Resume
Hollie C. Peterson ResumeHollie C. Peterson Resume
Hollie C. Peterson Resume
 
Inferior Vena Cava Disorders
Inferior Vena Cava DisordersInferior Vena Cava Disorders
Inferior Vena Cava Disorders
 
Septal Ablations Presentation
Septal Ablations PresentationSeptal Ablations Presentation
Septal Ablations Presentation
 

Kürzlich hochgeladen

Call Girls in Gagan Vihar (delhi) call me [🔝 9953056974 🔝] escort service 24X7
Call Girls in Gagan Vihar (delhi) call me [🔝  9953056974 🔝] escort service 24X7Call Girls in Gagan Vihar (delhi) call me [🔝  9953056974 🔝] escort service 24X7
Call Girls in Gagan Vihar (delhi) call me [🔝 9953056974 🔝] escort service 24X7
9953056974 Low Rate Call Girls In Saket, Delhi NCR
 

Kürzlich hochgeladen (20)

Night 7k to 12k Navi Mumbai Call Girl Photo 👉 BOOK NOW 9833363713 👈 ♀️ night ...
Night 7k to 12k Navi Mumbai Call Girl Photo 👉 BOOK NOW 9833363713 👈 ♀️ night ...Night 7k to 12k Navi Mumbai Call Girl Photo 👉 BOOK NOW 9833363713 👈 ♀️ night ...
Night 7k to 12k Navi Mumbai Call Girl Photo 👉 BOOK NOW 9833363713 👈 ♀️ night ...
 
Best Rate (Guwahati ) Call Girls Guwahati ⟟ 8617370543 ⟟ High Class Call Girl...
Best Rate (Guwahati ) Call Girls Guwahati ⟟ 8617370543 ⟟ High Class Call Girl...Best Rate (Guwahati ) Call Girls Guwahati ⟟ 8617370543 ⟟ High Class Call Girl...
Best Rate (Guwahati ) Call Girls Guwahati ⟟ 8617370543 ⟟ High Class Call Girl...
 
The Most Attractive Hyderabad Call Girls Kothapet 𖠋 9332606886 𖠋 Will You Mis...
The Most Attractive Hyderabad Call Girls Kothapet 𖠋 9332606886 𖠋 Will You Mis...The Most Attractive Hyderabad Call Girls Kothapet 𖠋 9332606886 𖠋 Will You Mis...
The Most Attractive Hyderabad Call Girls Kothapet 𖠋 9332606886 𖠋 Will You Mis...
 
Best Rate (Patna ) Call Girls Patna ⟟ 8617370543 ⟟ High Class Call Girl In 5 ...
Best Rate (Patna ) Call Girls Patna ⟟ 8617370543 ⟟ High Class Call Girl In 5 ...Best Rate (Patna ) Call Girls Patna ⟟ 8617370543 ⟟ High Class Call Girl In 5 ...
Best Rate (Patna ) Call Girls Patna ⟟ 8617370543 ⟟ High Class Call Girl In 5 ...
 
Top Rated Hyderabad Call Girls Erragadda ⟟ 9332606886 ⟟ Call Me For Genuine ...
Top Rated  Hyderabad Call Girls Erragadda ⟟ 9332606886 ⟟ Call Me For Genuine ...Top Rated  Hyderabad Call Girls Erragadda ⟟ 9332606886 ⟟ Call Me For Genuine ...
Top Rated Hyderabad Call Girls Erragadda ⟟ 9332606886 ⟟ Call Me For Genuine ...
 
(Low Rate RASHMI ) Rate Of Call Girls Jaipur ❣ 8445551418 ❣ Elite Models & Ce...
(Low Rate RASHMI ) Rate Of Call Girls Jaipur ❣ 8445551418 ❣ Elite Models & Ce...(Low Rate RASHMI ) Rate Of Call Girls Jaipur ❣ 8445551418 ❣ Elite Models & Ce...
(Low Rate RASHMI ) Rate Of Call Girls Jaipur ❣ 8445551418 ❣ Elite Models & Ce...
 
Premium Call Girls Cottonpet Whatsapp 7001035870 Independent Escort Service
Premium Call Girls Cottonpet Whatsapp 7001035870 Independent Escort ServicePremium Call Girls Cottonpet Whatsapp 7001035870 Independent Escort Service
Premium Call Girls Cottonpet Whatsapp 7001035870 Independent Escort Service
 
♛VVIP Hyderabad Call Girls Chintalkunta🖕7001035870🖕Riya Kappor Top Call Girl ...
♛VVIP Hyderabad Call Girls Chintalkunta🖕7001035870🖕Riya Kappor Top Call Girl ...♛VVIP Hyderabad Call Girls Chintalkunta🖕7001035870🖕Riya Kappor Top Call Girl ...
♛VVIP Hyderabad Call Girls Chintalkunta🖕7001035870🖕Riya Kappor Top Call Girl ...
 
O898O367676 Call Girls In Ahmedabad Escort Service Available 24×7 In Ahmedabad
O898O367676 Call Girls In Ahmedabad Escort Service Available 24×7 In AhmedabadO898O367676 Call Girls In Ahmedabad Escort Service Available 24×7 In Ahmedabad
O898O367676 Call Girls In Ahmedabad Escort Service Available 24×7 In Ahmedabad
 
Call Girls Siliguri Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Siliguri Just Call 8250077686 Top Class Call Girl Service AvailableCall Girls Siliguri Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Siliguri Just Call 8250077686 Top Class Call Girl Service Available
 
Premium Bangalore Call Girls Jigani Dail 6378878445 Escort Service For Hot Ma...
Premium Bangalore Call Girls Jigani Dail 6378878445 Escort Service For Hot Ma...Premium Bangalore Call Girls Jigani Dail 6378878445 Escort Service For Hot Ma...
Premium Bangalore Call Girls Jigani Dail 6378878445 Escort Service For Hot Ma...
 
Call Girls in Gagan Vihar (delhi) call me [🔝 9953056974 🔝] escort service 24X7
Call Girls in Gagan Vihar (delhi) call me [🔝  9953056974 🔝] escort service 24X7Call Girls in Gagan Vihar (delhi) call me [🔝  9953056974 🔝] escort service 24X7
Call Girls in Gagan Vihar (delhi) call me [🔝 9953056974 🔝] escort service 24X7
 
VIP Service Call Girls Sindhi Colony 📳 7877925207 For 18+ VIP Call Girl At Th...
VIP Service Call Girls Sindhi Colony 📳 7877925207 For 18+ VIP Call Girl At Th...VIP Service Call Girls Sindhi Colony 📳 7877925207 For 18+ VIP Call Girl At Th...
VIP Service Call Girls Sindhi Colony 📳 7877925207 For 18+ VIP Call Girl At Th...
 
Call Girls Faridabad Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Faridabad Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Faridabad Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Faridabad Just Call 9907093804 Top Class Call Girl Service Available
 
Top Quality Call Girl Service Kalyanpur 6378878445 Available Call Girls Any Time
Top Quality Call Girl Service Kalyanpur 6378878445 Available Call Girls Any TimeTop Quality Call Girl Service Kalyanpur 6378878445 Available Call Girls Any Time
Top Quality Call Girl Service Kalyanpur 6378878445 Available Call Girls Any Time
 
Call Girls Bangalore Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Bangalore Just Call 8250077686 Top Class Call Girl Service AvailableCall Girls Bangalore Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Bangalore Just Call 8250077686 Top Class Call Girl Service Available
 
Call Girls Kochi Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Kochi Just Call 8250077686 Top Class Call Girl Service AvailableCall Girls Kochi Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Kochi Just Call 8250077686 Top Class Call Girl Service Available
 
Russian Call Girls Service Jaipur {8445551418} ❤️PALLAVI VIP Jaipur Call Gir...
Russian Call Girls Service  Jaipur {8445551418} ❤️PALLAVI VIP Jaipur Call Gir...Russian Call Girls Service  Jaipur {8445551418} ❤️PALLAVI VIP Jaipur Call Gir...
Russian Call Girls Service Jaipur {8445551418} ❤️PALLAVI VIP Jaipur Call Gir...
 
All Time Service Available Call Girls Marine Drive 📳 9820252231 For 18+ VIP C...
All Time Service Available Call Girls Marine Drive 📳 9820252231 For 18+ VIP C...All Time Service Available Call Girls Marine Drive 📳 9820252231 For 18+ VIP C...
All Time Service Available Call Girls Marine Drive 📳 9820252231 For 18+ VIP C...
 
Book Paid Powai Call Girls Mumbai 𖠋 9930245274 𖠋Low Budget Full Independent H...
Book Paid Powai Call Girls Mumbai 𖠋 9930245274 𖠋Low Budget Full Independent H...Book Paid Powai Call Girls Mumbai 𖠋 9930245274 𖠋Low Budget Full Independent H...
Book Paid Powai Call Girls Mumbai 𖠋 9930245274 𖠋Low Budget Full Independent H...
 

Appropriate Arterial Testing

  • 2. Created in response to increased effort to rationally use imaging services Ensure high-quality care Diagnostic imaging services Medicare reimbursement grew more rapidly than any other physician service from 1999 to 2003 American College of Cardiology Foundation (ACCF) partnered with specialty + subspecialty societies to review common clinical scenarios
  • 3. Appropriate Use Criteria Continued… 255 Clinical Scenarios (indications) scored on scale 1 to 9 Appropriate (7 to 9) 177 indications Uncertain “Gray Zone” (4 to 6) 84 indications Inappropriate (1 to 3) 54 indications This effort has potential to impact physician decision making, healthcare delivery, & reimbursement policy Scenarios were evaluated for 8 different arterial tests
  • 4. Types of Arterial Exams Extracranial Cerebrovascular Duplex Carotid Duplex Screening Renal & Mesenteric Artery Duplex Aortic & Aortoiliac Duplex LE Artery Testing (Multilevel Physiological Testing Alone or Duplex Ultrasound with Single-Level ABI & PVR) LE Artery Testing with ABI only LE Artery with Duplex only UE Arterial Testing (Physiological Testing or Duplex Ultrasound)
  • 5. Extracranial Cerebrovascular Duplex Ultrasound What is it? Ultrasound study done to assess blood flow of carotid and vertebral arteries outside the skull
  • 6. Appropriate  Neurological symptoms  Suspected vertebrobasilar symptoms (present circulation symptoms)  Evaluation of TIA or stroke Inappropriate  Carotid Artery Stenosis Surveillance (mild to moderate) “Gray Zone”  Prior to open heart surgery  Syncope symptoms
  • 7. Carotid Duplex Screening What is it? Limited ultrasound study done to assess blood flow of arteries that supply blood from heart up through the neck into the brain
  • 8. Appropriate  Dissection arising from aortic arch into arch vessels (CCA)  Inner lining tears allowing blood to flow into a “false lumen” Inappropriate  Trauma induced dissection  Normal baseline carotid follow-up  Repeat studies for moderate ICA lesions within first year  Low to moderate Framingham risk score  Risk of having heart attack in the next 10 years “Gray Zone”  Surveillance beyond first year (normal carotid stenosis)  Intermediate to high Framingham risk score
  • 9. Renal & Mesenteric Artery Duplex What is it? Renal Duplex: Ultrasound study done to evaluate the renal arteries that feed the kidneys. Mesenteric Duplex: Ultrasound study done to evaluate the arteries supplying blood flow to organs involved with digestion.
  • 10. Renal Mesenteric  Appropriate  HTN  Creatinine (elevated)  Heart failure  Inappropriate  PAD  “Gray Zone”  Enlarged Kidney  Appropriate  Postprandial (after dinner/lunch) pain  Weight loss  GI evaluation completed  Inappropriate  Incomplete GI exam  Acute abdominal pain  “Gray Zone”  Abdominal bruit
  • 11. Aortic & Aortoiliac Duplex What is it? Ultrasound study performed to evaluate the aorta (the main artery in the abdomen) and surrounding arteries that deliver blood to major organs in the body.
  • 12. Appropriate  Intermittent claudication  Aneurysmal femoral/Popliteal Pulse  Abdominal/femoral bruit Inappropriate  LE discomfort  Fever  LE swelling  HTN “Gray Zone”  Erectile Dysfunction
  • 13. LE Artery Testing: Multi-level Physiological Testing Alone or Duplex Ultrasound with Single-level ABI & PVR What is it? Multi-level Physiological Testing: Segmental Pressures are taken from the ankle up to the thigh (3 cuffs or 4 cuffs) to determine if pressure differences exist (>30 mmHg) Single Level: Ankle Brachial Index (ABI) is found by dividing highest arm pressure by highest ankle pressure. Pulse Volume Recording (PVR) is used to measure volume changes in limb pressures from the thigh down to the ankle.
  • 14. Appropriate  LE Claudication, rest pain  Ulcers, gangrene, ischemia  Normal/Abnormal ABI (new or worsening symptoms) Inappropriate  Symptoms present along with normal pulses  Ex. Nocturnal leg cramps, neuropathy, LE swelling or hair loss
  • 15. LE Artery Testing: ABI only What is it? Physiological test done to determine the ratio of ankle systolic pressure to arm systolic pressure, which the numerical index serving as an indicator of arterial insufficiency (Normal= > 1.0)
  • 16. Appropriate  Diminished pulses  Femoral Bruit  >50 years old with diabetes or smoking “Gray Zone”  <50 years old with diabetes
  • 17. LE Artery Testing: Duplex only What is it? Ultrasound study performed to evaluate the arteries of the legs in order to identify narrowing of vessels.
  • 18. Appropriate  Groin symptoms o Ex. Pulsatile mass, Bruit or thrill, severe pain post- procedure  Significant hematoma (solid swell of blood in tissues) “Gray Zone”  Ecchymosis (Discoloration of skin resulting from bleeding underneath)
  • 19. UE Arterial Testing: Physiological Test or Duplex Ultrasound What is it? Physiological: segmental pressures are taken in the upper extremity arteries to determine presence, severity, and location of arterial occlusive disease Duplex: Ultrasound study performed to evaluate the arteries of the arms in order to identify narrowing of vessels.
  • 20. Appropriate  Claudication, ulceration, ischemia, bruit  Unilateral cold painful hand  UE trauma due to vascular harvest “Gray Zone”  Raynaud’s phenomenon  Vasospastic disorder  >20 mmHg brachial pressure difference  Periclavicular (around the clavicle) bruit
  • 21.  A 72 year old male complains of rest pain symptoms. He is diabetic and has smoked 2 packs per day for 50 years.  LE Arterial Testing with ABI only  A 75 yr old woman presents with temporal headaches. Additionally, she complains of muscle aching in shoulders + arm fatigue with physical activity.  UE Arterial Physiological Test (segmental pressures) + Duplex (if pressure difference is found) Patient Example
  • 22. Policy Recommendations: Cost Effective Research Educate students Education seminar for physicians

Hinweis der Redaktion

  1. Each of the categories are broken down into three main uses: Appropriate, Inappropriate, “Gray Zone”
  2. --Trauma induced dissection (distal dissection in ICA may not be detected)
  3. Peripheral Artery Disease (PAD) Hypertension (HTN) Gastrointestinal (GI) Post prandial: after a meal
  4. Periclavicular Raynaud’s phenomenon: narrowing of blood vessels in fingers and toes due to occupational injury