American College of Radiology
ACR Appropriateness Criteria®

Lower Extremity Arterial Revascularization–Post-Therapy Imaging

Variant 1: Previous infrainguinal endovascular therapy or bypass. Asymptomatic. Surveillance.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
US duplex Doppler lower extremity Usually appropriate O 0 mSv O 0 mSv [ped] 8 8 1 0 0 0 0 3 1 4 7
MRA lower extremity without IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 3 3 1 4 5 2 2 1 1 0 0
MRA lower extremity without and with IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 3 3 0 6 8 1 0 0 0 0 0
CTA lower extremity with IV contrast Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 0 5 9 1 0 0 0 0 0
Arteriography lower extremity Usually not appropriate ☢☢ 0.1-1mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 10 2 2 0 1 0 0 1 0
Variant 2: Previous infrainguinal endovascular therapy or bypass. Claudication or CLI. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
US duplex Doppler lower extremity Usually appropriate O 0 mSv O 0 mSv [ped] 9 9 1 0 0 0 0 0 0 4 11
CTA lower extremity with IV contrast Usually appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 8 8 0 0 1 0 0 0 4 8 3
MRA lower extremity without and with IV contrast Usually appropriate O 0 mSv O 0 mSv [ped] 8 8 0 0 1 1 1 0 5 7 1
Arteriography lower extremity May be appropriate ☢☢ 0.1-1mSv ☢☢☢ 0.3-3 mSv [ped] 5 5 0 0 0 3 10 1 1 0 0
MRA lower extremity without IV contrast May be appropriate O 0 mSv O 0 mSv [ped] 5 5 0 0 1 0 9 4 1 0 0
Variant 3: Previous infrainguinal endovascular therapy or bypass, presenting with cold, painful extremity and diminished pulses (acute limb ischemia). Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Arteriography lower extremity Usually appropriate ☢☢ 0.1-1mSv ☢☢☢ 0.3-3 mSv [ped] 8 8 0 1 0 0 0 0 2 8 5
CTA lower extremity with IV contrast Usually appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 8 8 0 1 0 0 2 1 2 5 5
US duplex Doppler lower extremity Usually appropriate O 0 mSv O 0 mSv [ped] 7 7 0 0 1 0 1 3 4 4 3
MRA lower extremity without and with IV contrast May be appropriate (Disagreement) O 0 mSv O 0 mSv [ped] 5 4 0 2 1 6 4 0 2 0 0
MRA lower extremity without IV contrast May be appropriate O 0 mSv O 0 mSv [ped] 4 4 1 3 3 2 5 1 1 0 0
Please refer to the supporting documentation for a more complete discussion of the concepts and their definitions below.
Final Tabulations:
A histogram of the number of panel members who rated the recommendation as noted in the column heading (ie, 1, 2, 3, …etc.)
Disagree:
The variation of the individual ratings from the median rating indicates panel disagreement on the final recommendation.
References:
Lists the references associated with the recommendation
SQ:
Study Quality (1, 2, 3, 4, Good M or Inadequate M) of the references listed.
RRL:
Information on the Relative Radiation Level (RRL) designations can be found here.