News | Peripheral Artery Disease (PAD) | December 19, 2018

New Appropriate Use Criteria Released for Peripheral Artery Interventions

Multi-society guidelines discuss surgical and endovascular options for treating peripheral artery disease

New Appropriate Use Criteria Released for Peripheral Artery Interventions

December 19, 2018 — A new set of appropriate use criteria (AUC) released Dec. 17 by a group of cardiovascular professional societies provide guidelines for peripheral artery interventions. The purpose of the AUC is to provide guidance to clinicians who may refer patients for revascularization treatments and to interventionalists and surgeons themselves. With the field of peripheral artery disease constantly evolving, it is imperative to offer tools and resources that physicians can utilize to provide the best care for their patients.

The AUC were jointly released by the American College of Cardiology (ACC), American Heart Association (AHA), Society for Cardiovascular Angiography and Interventions (SCAI) and the Society for Vascular Medicine (SVM).  

The following are key points to remember listed on the ACC website:

  1. The patient scenarios are not intended to be comprehensive, but instead to address scenarios common in clinical practice with associated assumptions and definitions. A total of 45 clinical scenarios with up to six intervention options each were developed. A separate, independent rating panel then evaluated each indication using a scoring scale from 1-9, with scores of 7-9 corresponding to “appropriate,” scores from 4-6 corresponding to “may be appropriate,” and scores of 1-3 corresponding to “rarely appropriate.”
  2. An appropriate treatment is one where the potential survival or health outcomes benefits exceed the potential negative consequences of the treatment strategy. “May be appropriate” suggests that a treatment should be contingent on individual patient circumstances and shared decision making based on patient and provider preferences. Multiple therapies may be required in an individual patient, and “rarely appropriate” is not equivalent to “inappropriate” or “never appropriate.”
  3. Emphasis was placed on adhering to and exhausting medical therapy to achieve maximal benefit in situations where symptom management was desired or incidental disease was discovered. Other factors that were considered included symptom burden, anatomic distribution and ischemic burden.
  4. Factors to consider when evaluating appropriateness for intervention for hemodynamically significant renal artery stenosis include: the indication (i.e., chronic kidney disease, hypertension, cardiac destabilization or incidentally discovered), the severity of symptoms (including the rapidity of decline in renal function and/or response to antihypertensive medications), and whether renal artery stenosis is unilateral versus bilateral or affecting a solitary viable kidney.
  5. Factors to consider when evaluating appropriateness of lower extremity intervention for claudication include: previous medical therapy, lesion location (aortoiliac, femoral-popliteal or below knee), and whether the lesion is stenotic versus a chronic total occlusion.
  6. Both endovascular and surgical treatment for critical limb ischemia were considered "appropriate" by the rating panel for all anatomic subsets (aortoiliac, femoral-popliteal or below knee). Continuation or intensification of medical therapy is not considered a reasonable treatment in patients with this diagnosis.
  7. Appropriate peripheral procedures for asymptomatic disease were based on expert consensus and included specific scenarios where arterial access would facilitate other necessary cardiovascular procedures, some of which may be life-saving (e.g., transcatheter aortic valve replacement [TAVR], hemodynamic support devices, etc.).
  8. Factors that should be considered when choosing between endovascular treatment options include the anatomic location and length of the lesion, and presence of discrete/focal stenosis, diffuse stenosis or chronic total occlusion.
  9. Factors that should be considered when evaluating appropriateness of secondary lower extremity intervention for in-stent restenosis or bypass failure include presence of diffuse versus focal stenosis, whether the bypass is stenotic versus thrombosed, and whether the bypass graft is a vein or prosthetic conduit.

The full guidelines are published in the Journal of the American College of Cardiology and can be read here.

For more information:

Related Content

SherpaPak Cardiac Transport System Cleared for Pediatric and Small Donor Hearts
Technology | Cardiovascular Surgery | February 01, 2019
Paragonix Technologies Inc. recently received clearance from the U.S. Food and Drug Administration (FDA) for a design...
Transplanting Pig Hearts Into Humans One Step Closer. A pig heart, shown here, is very similar in size and anatomy to a human heart. For this reason, pigs are used extensively in pre-clinical animal testing for new implantable cardiovascular devices. If pig hearts could be used for human transplantation, it would greatly alleviate shortages of donor human hearts.

A pig heart, shown here, is very similar in size and anatomy to a human heart. For this reason, pigs are used extensively in pre-clinical animal testing for new implantable cardiovascular devices. If pig hearts could be used for human transplantation, it would greatly alleviate shortages of donor human hearts.

News | Cardiovascular Surgery | December 11, 2018
The scientific journal Nature recently published an article from Munich University Hospital which describes the long-...
Bilateral Artery Use Does Not Improve 10-Year CABG Outcomes
News | Cardiovascular Surgery | September 06, 2018
While it is firmly established that the use of one internal thoracic artery can improve life expectancy in coronary...
Mandatory Public Coronary Artery Bypass Grafting Reporting Associated With Better Patient Outcomes
News | Cardiovascular Surgery | April 30, 2018
Mandatory public reporting of coronary artery bypass grafting (CABG) results in Massachusetts was associated with...
Gecko Biomedical Receives CE Mark Approval for Setalum Sealant
News | Cardiovascular Surgery | September 19, 2017
Gecko Biomedical announced it has received CE Mark approval for its Setalum Sealant, allowing the company to market its...
ClearFlow Inc. Announces Positive U.S. Clinical Trial Results
News | Cardiovascular Surgery | September 08, 2017
September 8, 2017 — ClearFlow Inc.
Videos | Cardiovascular Surgery | July 19, 2017
This video educational session, provided in partnership with the American Society of Echocardiography (ASE), is title
Intensive Glycemic Control Program Produces Significant Per-Patient Cost Savings for CABG Surgery
News | Cardiovascular Surgery | May 25, 2017
A new study from Emory University observed a near-20 percent reduction in perioperative complications, a 1.2-day...
Risk of Heart Transplant Rejection Reduced by Desensitizing Patient Antibodies
News | Cardiovascular Surgery | May 23, 2017
The risk of heart transplant rejection can be reduced by desensitizing patient antibodies, according to research...
Overlay Init