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Appropriateness Criteria

Variant 1: Acute iliofemoral DVT with mild symptoms less than 14 days, otherwise healthy.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Anticoagulation alone Usually appropriate Limited N/A N/A 8 8 1 0 0 1 0 0 2 5 6
References Study Quality
5 (26867832) 4
7 (24576432) 1
6 (31054748) 4
Graded compression stocking therapy May be appropriate Strong N/A N/A 6 6 0 0 0 1 6 4 3 1 0
References Study Quality
12 (27245485) 1
10 (25059736) 1
11 (24315521) 1
14 (27264039) Good
13 (27026391) Good
9 (27058800) Inadequate
CDT/PMT with or without stent placement Usually not appropriate Strong N/A N/A 3 3 1 3 4 3 1 2 0 0 0
References Study Quality
8 (29211671) 1
3 (26853645) 1
Surgical thrombectomy techniques Usually not appropriate Limited N/A N/A 2 2 6 3 3 1 0 0 0 0 1
References Study Quality
15 (22312072) 4
Variant 2: Acute iliofemoral DVT with moderate to severe symptoms present for less than 14 days, otherwise healthy.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
CDT/PMT with or without stent placement Usually appropriate Strong N/A N/A 8 8 0 0 0 1 1 4 1 4 3
References Study Quality
19 (24934734) 3
8 (29211671) 1
3 (26853645) 1
18 (23689427) 4
16 (27830895) 4
17 (30586751) 1
Anticoagulation alone Usually appropriate Limited N/A N/A 7 7 0 0 1 1 1 0 5 6 1
References Study Quality
5 (26867832) 4
Surgical thrombectomy techniques May be appropriate Limited N/A N/A 5 5 0 2 2 3 5 1 1 0 0
References Study Quality
15 (22312072) 4
21 (29502771) 4
20 (20060755) 4
22 (9413377) 1
23 (28214484) 3
Variant 3: Acute femoropopliteal DVT with mild to moderate symptoms present for less than 14 days, otherwise healthy.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Anticoagulation alone Usually appropriate Limited N/A N/A 9 9 1 0 0 0 2 0 1 3 7
References Study Quality
5 (26867832) 4
Graded compression stocking therapy May be appropriate Strong N/A N/A 6 6 0 0 0 1 5 7 2 0 0
References Study Quality
12 (27245485) 1
10 (25059736) 1
11 (24315521) 1
14 (27264039) Good
13 (27026391) Good
9 (27058800) Inadequate
CDT/PMT Usually not appropriate Limited N/A N/A 3 3 1 3 7 1 3 0 0 0 0
References Study Quality
8 (29211671) 1
15 (22312072) 4
Variant 4: Acute iliofemoral DVT and symptoms less than 14 days. Cross-sectional imaging consistent with May-Thurner syndrome.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
CDT/PMT with or without stent placement Usually appropriate Limited N/A N/A 8 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
28 (23761876) 4
29 (24183245) 2
27 (28667425) 4
Anticoagulation alone May be appropriate Limited N/A N/A 5 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
5 (26867832) 4
24 (25502563) 4
26 (9737459) 4
25 (18241761) 4
Hybrid surgical thrombectomy with stenting May be appropriate Limited N/A N/A 4 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
30 (24284504) 4
23 (28214484) 3
Variant 5: Acute iliofemoral DVT and limb-threatening ischemia (phlegmasia cerulea dolens).
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
CDT/PMT with or without stent placement Usually appropriate Limited N/A N/A 7 7 0 0 0 1 1 1 6 2 3
References Study Quality
32 (26993678) 3
31 (24428096) 4
15 (22312072) 4
21 (29502771) 4
Surgical thrombectomy with or without stent placement Usually appropriate Limited N/A N/A 7 7 0 0 0 1 4 2 3 3 1
References Study Quality
32 (26993678) 3
31 (24428096) 4
15 (22312072) 4
21 (29502771) 4
Systemic thrombolysis May be appropriate Limited N/A N/A 4 4 1 2 3 3 4 1 0 0 0
References Study Quality
16 (27830895) 4
Anticoagulation alone Usually not appropriate Expert Consensus N/A N/A 2 2 5 3 6 1 0 0 0 0 0
Variant 6: Iliofemoral DVT with persistent moderate symptoms at least 3 months after initial treatment with anticoagulation alone.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Anticoagulation alone May be appropriate Limited N/A N/A 6 6 0 0 0 1 4 5 4 0 0
References Study Quality
5 (26867832) 4
CDT/PMT with or without stent placement May be appropriate Strong N/A N/A 6 6 0 0 0 1 1 8 3 2 0
References Study Quality
33 (28110873) 4
35 (24768326) 4
37 (24091759) 1
34 (23512690) 4
36 (25920630) 2
Graded compression stocking therapy May be appropriate Strong N/A N/A 6 6 0 1 0 2 2 8 1 1 0
References Study Quality
12 (27245485) 1
10 (25059736) 1
11 (24315521) 1
14 (27264039) Good
13 (27026391) Good
9 (27058800) Inadequate
Surgical thrombectomy with or without stent placement May be appropriate (Disagreement) Expert Opinion N/A N/A 5 5 0 3 2 5 1 4 0 0 0
References Study Quality
39 (28731380) 4
40 (26238309) 4
38 (21890310) 4
Variant 7: Acute iliofemoral DVT in a pregnant patient with moderate to severe symptoms.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Anticoagulation alone Usually appropriate Limited N/A N/A 8 8 0 1 0 0 0 0 3 9 2
References Study Quality
5 (26867832) 4
42 (25899048) 4
44 (23958068) 4
21 (29502771) 4
41 (26780741) 4
43 (29399535) 4
CDT/PMT with or without stent placement May be appropriate Limited N/A N/A 6 6 0 0 1 0 5 5 2 1 0
References Study Quality
42 (25899048) 4
44 (23958068) 4
21 (29502771) 4
43 (29399535) 4
Graded compression stocking therapy May be appropriate Strong N/A N/A 5 5 0 0 1 1 6 1 4 1 0
References Study Quality
12 (27245485) 1
10 (25059736) 1
11 (24315521) 1
14 (27264039) Good
13 (27026391) Good
9 (27058800) Inadequate
Surgical thrombectomy with or without stent placement May be appropriate Limited N/A N/A 5 5 0 1 3 3 3 3 0 1 0
References Study Quality
44 (23958068) 4
21 (29502771) 4
43 (29399535) 4
45 (12618687) 2
Appendix Key

A more complete discussion of the items presented below can be found by accessing the supporting documents at the designated hyperlinks.

Appropriateness Category:The panel’s recommendation for a procedure based on the assessment of the risks and benefits of performing the procedure for the specified clinical scenario.

SOE: Strength of Evidence. The assessment of the amount and quality of evidence found in the peer reviewed medical literature for an appropriateness recommendation.

  • References: The citation number and PMID for the reference(s) associated with the recommendation.
  • Study Quality: The assessment of the quality of an individual reference based on the number of study quality elements described in the reference.

RRL: Relative Radiation Level. A population based assessment of the amount of radiation a typical patient may be exposed to during the specified procedure.

Rating: The final rating (1-9 scale) for the procedure as determined by the panel during rating rounds.

Median: The median rating (1-9 scale) for the procedure as determined by the panel during rating rounds.

Final tabulations: A histogram showing the number of panel members who rated the procedure as noted in the column heading (ie, 1, 2, 3, etc.).

Additional supporting documents about the AC methodology and processes can be found at www.acr.org/ac.