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Appropriateness Criteria

Reference Study Type Patients/Events Study Objective(Purpose of Study) Study Results Study Quality
1. Chu LC, Johnson PT, Dietz HC, Fishman EK. CT angiographic evaluation of genetic vascular disease: role in detection, staging, and management of complex vascular pathologic conditions. [Review]. AJR Am J Roentgenol. 202(5):1120-9, 2014 May. Review/Other-Dx N/A To provide a detailed analysis of cardiovascular involvement in Marfan syndrome, Loeys-Dietz syndrome, and vascular Ehlers-Danlos syndrome. Although these syndromes share some overlapping features, they have discriminating clinical and imaging features, and knowledge of these features enables the radiologist to aid the referring clinician in making the correct diagnosis. 4
2. Dimmick SJ, Goh AC, Cauzza E, et al. Imaging appearances of Buerger's disease complications in the upper and lower limbs. Clin Radiol. 2012;67(12):1207-1211. Review/Other-Dx N/A To present the radiological appearance of the sequelae of Buerger's disease involving the upper and lower limbs. No results stated in abstract. 4
3. Kalra VB, Gilbert JW, Malhotra A. Loeys-Dietz syndrome: cardiovascular, neuroradiological and musculoskeletal imaging findings. Pediatr Radiol. 2011;41(12):1495-1504; quiz 1616. Review/Other-Dx N/A To focus on the cardiovascular, neuroradiological and musculoskeletal imaging findings in this disorder and recommendations for follow-up imaging. No results stated in abstract. 4
4. Zilocchi M, Macedo TA, Oderich GS, Vrtiska TJ, Biondetti PR, Stanson AW. Vascular Ehlers-Danlos syndrome: imaging findings. AJR Am J Roentgenol. 2007;189(3):712-719. Review/Other-Dx 28 patients To review the imaging findings in a cohort of patients with a diagnosis of vascular Ehlers-Danlos syndrome. Vascular abnormalities were present in 22 (78%) of 28 patients. Arterial abnormalities included 41 aneurysms, 19 dissections, 12 ectasias, and 10 occlusions. There was one splenic vein aneurysm and one carotid cavernous fistula. Six patients had a total of 10 parenchymal infarcts involving the brain (n = 5), kidney (n = 3), and spleen (n = 2). Nine patients had 10 hemorrhagic events, five related to spontaneous vascular rupture and five associated with interventional or surgical procedures. Six patients had 13 nonvascular findings. 4
5. Goh BK, Tay KH, Tan SG. Diagnosis and surgical management of popliteal artery entrapment syndrome. ANZ J Surg. 2005;75(10):869-873. Review/Other-Tx 6 patients; 8 limbs To report the authors' experience of surgically treating eight limbs in six patients for popliteal artery entrapment syndrome (PAES), over a 10-year period. There were six patients with a mean age of 34 years (range, 27-38 years) at diagnosis and five of them were male. Two patients were found to have bilateral involvement. Both patients had symptoms involving both limbs and underwent bilateral surgery. Intermittent claudication was the most frequent presenting symptom (seven of eight limbs). All the patients had Delaney's type III PAES. Popliteal artery release was performed in all eight limbs and this was combined with a vein patch or a reversed long saphenous vein bypass graft in four limbs because the arteries in these four limbs were diseased or occluded. At a median follow up of 15 months (range, 40 days-9 years), five (seven limbs) of the six patients (eight limbs) were cured of their symptoms. One patient who presented late with rest pain and dusky toes underwent popliteal artery release, endarterectomy and a vein patch repair for an occluded popliteal artery. However, her limb could not be salvaged and her affected limb had to be amputated. 4
6. Ozkan U, Oguzkurt L, Tercan F, Pourbagher A. MRI and DSA findings in popliteal artery entrapment syndrome. Diagn Interv Radiol. 2008;14(2):106-110. Review/Other-Dx 6 patients; 7 limbs To evaluate magnetic resonance imaging (MRI) and digital subtraction angiography (DSA) findings in popliteal artery entrapment syndrome. MRI findings established the diagnosis of type-3 popliteal artery entrapment syndrome in 4 limbs, and type-2 in 3 limbs. Abnormal MRI findings included popliteal artery thrombosis with aneurysm in 2 limbs (29%), popliteal artery thrombosis without aneurysm in 1 limb (14%), aberrant fibrous band in 3 limbs (43%), aberrant thick muscle bundle in 1 limb (14%), insertion anomaly of medial head of the gastrocnemius muscle (MHG) in 3 limbs (43%), lateral deviation of the MHG in 4 limbs (57%), hypertrophy of the MHG in 1 limb (14%), and atrophy of the MHG in 2 limbs (29%). Deviation of the popliteal artery in 4 limbs (57%) and distal crural embolic occlusions in 2 limbs (29%) were detected with both angiography and MRI imaging. DSA was diagnostic in 2 limbs of 1 patient, and MRI was diagnostic in all limbs examined. 4
7. Pillai J. A current interpretation of popliteal vascular entrapment. J Vasc Surg. 2008;48(6 Suppl):61S-65S; discussion 65S. Review/Other-Dx N/A To review embryological anatomy, diagnosis, classification, and treatment of the popliteal entrapment syndrome. No results stated in abstract. 4
8. Pillai J, Levien LJ, Haagensen M, Candy G, Cluver MD, Veller MG. Assessment of the medial head of the gastrocnemius muscle in functional compression of the popliteal artery. J Vasc Surg. 2008;48(5):1189-1196. Experimental-Dx 88 patients: 50 men; 38 women To assess the attachment of the medial head of the gastrocnemius muscle in healthy occluders and healthy nonoccluders. In the occluder group, significantly more muscle was attached towards the femoral midline (supracondylar), around the lateral border of the medial condyle (pericondylar), and within the intercondylar fossa. 2
9. Diehm N, Kickuth R, Baumgartner I, et al. Magnetic resonance angiography in infrapopliteal arterial disease: prospective comparison of 1.5 and 3 Tesla magnetic resonance imaging. Invest Radiol. 2007;42(6):467-476. Observational-Dx 10 patients: 6 men; 4 women; 15 limbs To prospectively determine the accuracy of 1.5 Tesla (T) and 3 T magnetic resonance angiography (MRA) versus digital subtraction angiography (DSA) in the depiction of infrageniculate arteries in patients with symptomatic peripheral arterial disease. No significant difference in overall image quality, sufficiency for diagnosis, depiction of arterial anatomy, motion artifacts, and venous overlap was found comparing 1.5 T with 3 T MRA (P > 0.05 by Wilcoxon signed rank and as by Cohen k test). Overall sensitivity of 1.5 and 3 T MRA for detection of significant arterial stenosis was 79% and 82%, and specificity was 87% and 87% for both modalities, respectively. Interobserver agreement was excellent k > 0.8, P < 0.05) for 1.5 T as well as for 3 T MRA. SNR and SDNR were significantly increased using the 3 T system (average increase: 36.5%, P < 0.032 by t test, and 38.5%, P < 0.037 respectively). 2
10. Kalva SP, Mueller PR. Vascular imaging in the elderly. Radiol Clin North Am. 2008;46(4):663-683, v. Review/Other-Dx N/A To discuss the imaging of atherosclerosis affecting various vascular territories and pay special attention to the elderly population. The authors also discuss imaging findings of segmental arterial mediolysis, giant cell arteritis, and venous thromboembolism. No results stated in abstract. 4
11. American College of Radiology. ACR Appropriateness Criteria®: Suspected Lower-Extremity Deep Vein Thrombosis. Available at: https://acsearch.acr.org/docs/69416/Narrative/. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for a specific clinical condition. N/A 4
12. Expert Panel on Vascular Imaging:, Ahmed O, Hanley M, et al. ACR Appropriateness Criteria R Vascular Claudication-Assessment for Revascularization. [Review]. J. Am. Coll. Radiol.. 14(5S):S372-S379, 2017 May. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for vascular claudication, assessment for revascularization. No results stated in abstract. 4
13. Cooper K, Majdalany BS, Kalva SP, et al. ACR Appropriateness Criteria® Lower Extremity Arterial Revascularization-Post-Therapy Imaging. J Am Coll Radiol 2018;15:S104-S15. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for lower extremity arterial revascularization-post-therapy imaging. No results stated in abstract. 4
14. Expert Panel on Vascular Imaging:, Weiss CR, Azene EM, et al. ACR Appropriateness Criteria R Sudden Onset of Cold, Painful Leg. [Review]. J. Am. Coll. Radiol.. 14(5S):S307-S313, 2017 May. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for sudden onset of cold, painful leg. No results stated in abstract 4
15. Anil G, Tay KH, Howe TC, Tan BS. Dynamic computed tomography angiography: role in the evaluation of popliteal artery entrapment syndrome. Cardiovasc Intervent Radiol. 2011;34(2):259-270. Review/Other-Dx 8 patients; 13 limbs To review our experience with dynamic computed tomographic angiography (CTA) as an imaging modality in the evaluation of popliteal artery entrapment syndrome (PAES). No results stated in abstract 4
16. Causey MW, Quan RW, Curry TK, Singh N. Ultrasound is a critical adjunct in the diagnosis and treatment of popliteal entrapment syndrome. J Vasc Surg. 2013;57(6):1695-1697. Review/Other-Dx N/A To describe our approach and evidence-based evaluation of popliteal entrapment syndrome. Included is a technical description of our use of preoperative intravascular ultrasound for diagnosis and operative planning in combination with our utilization of intraoperative duplex ultrasound. No results stated in abstract 4
17. Kim SY, Min SK, Ahn S, Min SI, Ha J, Kim SJ. Long-term outcomes after revascularization for advanced popliteal artery entrapment syndrome with segmental arterial occlusion. J Vasc Surg. 2012;55(1):90-97. Observational-Tx 18 patients; 22 limbs To analyze the long-term result of revascularization surgery in patients with advanced popliteal artery entrapment syndrome during the last 16 years. The mean age was 31 years old and the majority of patients were men (94%). The chief complaints were claudication in 18 limbs, ischemic rest pain in three limbs, and toe necrosis in one limb. All 22 limbs underwent revascularization for advanced PAES with segmental arterial occlusion. Fourteen limbs underwent musculotendinous section and popliteo-popliteal interposition graft (13 posterior approaches, one medial approach), five femoropopliteal (below-knee) bypasses, one femoro-posterior tibial bypass, and two popliteo-posterior tibial bypasses. All revascularization surgeries were performed with reversed saphenous veins. The overall primary graft patency rates at 1, 3, and 5 years were 80.9%, 74.6%, and 74.6%, respectively. Comparing 5-year graft patency according to the extent of arterial occlusion, patients with occlusion confined to the popliteal artery (n = 14) showed a better patency rate than patients with occlusion extended beyond the popliteal artery (n = 8) with no statistical significance (83.6% vs 53.6%; P = .053). Comparing 5-year graft patency according to the inflow artery, superficial femoral artery inflow (n = 6) showed a worse patency rate than popliteal artery inflow (n = 16) (30.0% vs 85.9%; P = .015). 2
18. Lane R, Nguyen T, Cuzzilla M, Oomens D, Mohabbat W, Hazelton S. Functional popliteal entrapment syndrome in the sportsperson. Eur J Vasc Endovasc Surg. 43(1):81-7, 2012 Jan. Experimental-Dx 32 patients; 55 limbs To define the clinical syndrome of functional popliteal entrapment comparing pre and post surgical clinical outcomes with pre and post-operative provocative ultrasonic investigations. Further, to suggest a management pathway to differentiate chronic exertional compartment syndromes and concomitant venous popliteal compression. At 3 months, all 55 limbs had clinical follow up. 52 of the 55 limbs had follow up with ultrasound with provocative manoeuvres. The ABIs normalised in 46 (88%). There were 40 of 52 (76%) that became asymptomatic post surgery with a normal scan. There were 4 of 52 (8%) who were clinically asymptomatic but with residual obstruction on duplex and who were able to resume their usual lifestyle. There were 4 (8%) that had abnormal findings both on post-operative scan and clinically. Re-operation on 2 limbs corrected the duplex findings and the symptoms. There were 4 (8%) limbs that had normal duplexes but continued with symptoms albeit varied from the presenting symptoms. In the longer term, a further 2 became symptomatic at 2.8 years requiring a further successful intervention. (Concomitant popliteal venous obstruction was present in 5 limbs (10%) on standing.) 2
19. Zhong H, Gan J, Zhao Y, et al. Role of CT angiography in the diagnosis and treatment of popliteal vascular entrapment syndrome. AJR Am J Roentgenol. 2011;197(6):W1147-1154. Review/Other-Dx N/A To describe computed tomography angiographic findings in the diagnosis and treatment of popliteal vascular entrapment syndrome. No results stated in abstract 4
20. Collaborators I. Diagnosis and Management of Iliac Artery Endofibrosis: Results of a Delphi Consensus Study. Eur J Vasc Endovasc Surg 2016;52:90-8. Review/Other-Dx N/A To use a Delphi consensus methodology to explore areas of consensus and disagreement concerning the diagnosis and management of patients with suspected iliac endofibrosis. Initially there was agreement on the typical symptoms at presentation and the need for an exercise test in the diagnosis. Round 3 clarified that duplex ultrasound was a useful tool in the diagnosis of endofibrosis. There was consensus on the most appropriate type of surgery (endarterectomy and vein patch) and that endovascular interventions were inadvisable. The final round helped to inform aspects of the natural history and post-operative surveillance. Progression of the disease was likely with continued exercise but cessation may prevent progression. Surveillance after surgery is generally recommended yearly with at least a clinical assessment. 4
21. Falor AE, Zobel M, de Virgilio C. External iliac artery fibrosis in endurance athletes successfully treated with bypass grafting. Ann Vasc Surg. 2013;27(8):1183 e1181-1184. Review/Other-Tx N/A To describe a 47-year-old male competitive cyclist and a 52-year-old female former international triathlete, with unilateral and bilateral external artery occlusions, respectively, who presented with disabling claudication and an inability to cycle or run. No results stated in abstract 4
22. Shalhub S, Zierler RE, Smith W, Olmsted K, Clowes AW. Vasospasm as a cause for claudication in athletes with external iliac artery endofibrosis. J Vasc Surg. 2013;58(1):105-111. Review/Other-Dx 8 women patients To propose a hypothesis for the mechanism involved in the associated claudication. Eight women, presented with symptomatic EIAE. Two had bilateral EIAE. All were endurance athletes (three cyclists, one runner, and four were cyclists and runners). Median age at presentation was 42.5 years (range, 39-60 years). Median duration of symptoms was 5.5 years (range, 2-15 years). Diagnosis was confirmed with an exercise treadmill test modified to accommodate these patients' high level of conditioning and unmask the claudication. In the most recent two patients, marked EIA vasospasm was noted after exercise by duplex scanning. All patients were treated with EIA vein patch angioplasty. Follow-up ranged from 1 to 10 years. All had a normal result on the modified exercise treadmill test and resumed their athletic activities postoperatively. 4
23. Fujii Y, Soga J, Nakamura S, et al. Classification of corkscrew collaterals in thromboangiitis obliterans (Buerger's disease): relationship between corkscrew type and prevalence of ischemic ulcers. Circ J. 2010;74(8):1684-1688. Observational-Dx 28 patients To classify the angiographic findings of corkscrew collaterals and to evaluate the relationship between corkscrew collateral type and the severity of Buerger's disease. Corkscrew collaterals were assessed on digital subtraction angiography in lower extremities of 28 patients with Buerger's disease (55 limbs). The corkscrew sign was classified into 4 types by size and pattern as follows: type I, artery diameter >2 mm, large helical sign; type II, diameter >1.5 mm and <or=2 mm, medium helical sign; type III, diameter >or=1 mm and <or=1.5 mm, small helical sign; and type IV, diameter <1 mm, tiny helical sign. The prevalence of ischemic ulcers was significantly higher in patients with types III and IV corkscrew collaterals than in patients with types I and II corkscrew collaterals either below or above the knee. Multiple regression analysis indicated that types III and IV below the knee are independent predictors of risk of ischemic ulcers. 3
24. Dormand H, Mohiaddin RH. Cardiovascular magnetic resonance in Marfan syndrome. [Review]. J Cardiovasc Magn Reson. 15:33, 2013 Apr 15. Review/Other-Dx N/A To provide an overview of Marfan syndrome with an emphasis on cardiovascular complications and cardiovascular imaging. Both pre- and post-operative imaging is addressed with an explanation of surgical management. All relevant imaging modalities are discussed with a particular focus on cardiovascular MR. 4
25. Ketha SS, Bjarnason H, Oderich GS, Misra S. Clinical features and endovascular management of iliac artery fibromuscular dysplasia. J Vasc Interv Radiol. 25(6):949-53, 2014 Jun. Observational-Tx 14 patients To identify the spectrum of clinical presentation of iliac artery fibromuscular dysplasia (FMD) and to evaluate the outcomes of endovascular management of iliaca rtery FMD for claudication. In eight (57%) patients, iliac artery FMD was incidentally found on imaging. Lifestyle-limiting claudication involving one or both extremities was present in six (43%) patients. All six patients were reported to have mild peripheral arterial disease based on ankle-brachial index measurements (0.7-0.9). These six patients underwent 10 endovascular procedures for claudication, including angioplasty (n = 8) and self-expanding stent placement (n = 2). Mean symptom-free survival was 56.3 months. 3
26. Plouin PF, Perdu J, La Batide-Alanore A, Boutouyrie P, Gimenez-Roqueplo AP, Jeunemaitre X. Fibromuscular dysplasia. Orphanet J Rare Dis. 2007;2:28. Review/Other-Dx N/A No objective stated in abstract No results stated in abstract 4
27. Kalva SP, Somarouthu B, Jaff MR, Wicky S. Segmental arterial mediolysis: clinical and imaging features at presentation and during follow-up. J Vasc Interv Radiol. 2011;22(10):1380-1387. Review/Other-Dx 14 patients To review clinical and imaging features at presentation and during follow-up of patients with a suspected diagnosis of segmental arterial mediolysis All cases of SAM diagnosed at a single institution from 2000 to 2010 were included. Diagnosis was based on characteristic radiologic features in the absence of other plausible diagnoses. Medical records were reviewed for demographics, presenting symptoms, and laboratory and imaging findings at presentation and during follow-up. RESULTS: Fourteen patients (nine men; mean age, 53 y +/- 15) were diagnosed with SAM. Initial presentation included abdominal or flank pain (n = 8) and chest pain, headache, stroke, or suprapubic fullness (n = 1 each). Two patients were asymptomatic. Inflammatory markers were negative in all cases. Imaging at presentation revealed involvement of celiac (n = 7), common hepatic (n = 3), splenic (n = 2), superior mesenteric (n = 5), renal (n = 5), and iliac (n = 2) arteries and the abdominal aorta (n = 1). Imaging demonstrated arterial dissections (n = 10), fusiform aneurysms (n = 6), arterial wall thickening (n = 2), and artery occlusion (n = 1). Clinical follow-up was available in 13 patients (median, 25 mo). Symptoms improved (n = 4), resolved (n = 3), or remained stable (n = 2), and four patients experienced new symptoms. Follow-up imaging, available in 10 patients at a median of 33 months, demonstrated new dissections, aneurysms, or arterial occlusions in five patients, including carotid artery dissection in three. Imaging findings remained stable (n = 3), improved (n = 1), or resolved (n = 1). 4
28. Michael M, Widmer U, Wildermuth S, Barghorn A, Duewell S, Pfammatter T. Segmental arterial mediolysis: CTA findings at presentation and follow-up. AJR Am J Roentgenol. 2006;187(6):1463-1469. Review/Other-Dx 5 patients: 4 men; 1 woman To retrospectively describe the CT (computed tomography) angiography findings of this disease and the evolution of those findings over time in five patients. Comparison of CTA and digital subtraction angiography suggests that CTA is useful to diagnose symptomatic segmental arterial mediolysis. Midterm CTA follow-up (median, 3 years) indicates that segmental arterial mediolysis lesions may resolve or remain unchanged. 4
29. Shenouda M, Riga C, Naji Y, Renton S. Segmental arterial mediolysis: a systematic review of 85 cases. Ann Vasc Surg. 2014;28(1):269-277. Review/Other-Dx 85 patients To perform a systematic review of the literature published on SAM between 1976 and 2012 was performed, focusing on arterial involvement, diagnostic imaging modalities, mortality and morbidity rates, and in particular treatment outcomes with open versus endovascular intervention. Sixty-two studies reporting on 85 cases of SAM were reviewed. Sixty-nine percent of cases were diagnosed histologically (24% on autopsy). Angiography was the most common form of diagnostic imaging modality (56% of cases). Arterial involvement was largely abdominal or cranial, with splenic arterial involvement being the most prevalent (29% of cases). There was a total SAM-related mortality of 26%. Endovascular intervention, most commonly in the form of coil embolization of aneurysmal vessel(s), was successful in 88% of cases where attempted, with no reported mortality. There was a mortality rate of 9% where open surgery was attempted. 4
30. Slavin RE. Segmental arterial mediolysis: course, sequelae, prognosis, and pathologic-radiologic correlation. Cardiovasc Pathol. 2009;18(6):352-360. Review/Other-Dx N/A To address uncertainties concerning pathologic and radiologic correlations, the course of this disease, and aspects of its prognosis exist. Six angiographic presentations are identified: (a) arterial dilatation, (b) single aneurysm, (c) multiple aneurysms, (d) dissecting hematomas, (e) arterial stenosis, and (f) arterial occlusions. Pathologic correlations reveal that lytic loss of medial muscle causes arterial dilatation, dilated arterial gaps form aneurysms, dissections develop at arterial-medial gap junctions or from reparative granulation tissue and reparative alterations, and thrombi cause stenosis and occlusions. The most common radiologic findings at onset are aneurysms, arterial dilatation, and occlusions, while dissections and stenotic lesions often are delayed. These images correlate with the histologic evolution of segmental arterial mediolysis. 4
31. Paravastu SC, Regi JM, Turner DR, Gaines PA. A contemporary review of cystic adventitial disease. Vasc Endovascular Surg. 2012;46(1):5-14. Review/Other-Dx N/A No objective stated No results stated in abstract 4
32. Rouviere O, Feugier P, Gutierrez JP, Chevalier JM. Arterial endofibrosis in endurance athletes: angiographic features and classification. Radiology 2014;273:294-303. Review/Other-Tx 180 patients To describe the spectrum of angiographic features of arterial endofibrosis and to assess the patterns of associated lesions. This study assessed 180 patients (161 men, 19 women) with 195 symptomatic limbs (136 left-side limbs; P < .001). Angiography depicted 28 abnormalities in the CIA (27 stenoses, one dissection), 185 in the EIA (17 thromboses, 167 stenoses, one dissection), one in the common femoral artery (dissection), and 14 in the deep femoral artery (one thrombosis, 13 stenoses). CIA and EIA stenoses predominantly involved the distal and proximal third of the artery respectively. They were mild (CIA and EIA mean severity, 19% +/- 7 and 26% +/- 11, respectively) and long (45% +/- 26 and 51% +/- 26 of the artery, respectively). EIA stenoses were significantly longer in women (P < .003). Upon hip flexion, 23 CIA and 116 EIA stenoses showed kinking (mean amplitude, 76 degrees +/- 23 and 76 degrees +/- 30, respectively). All deep femoral artery stenoses were diaphragm-like and involved the lateral circumflex femoral artery. CIA, EIA, and femoral lesions were not randomly associated (P < .001). 4
33. Peach G, Schep G, Palfreeman R, Beard JD, Thompson MM, Hinchliffe RJ. Endofibrosis and kinking of the iliac arteries in athletes: a systematic review. Eur J Vasc Endovasc Surg. 2012;43(2):208-217. Review/Other-Dx N/A To examine the existing literature relating to these flow-limiting phenomena and identify a clear, unifying strategy for the assessment and management of affected patients. Examination can successfully identify nearly 80% of patients with iliac flow limitation. However, both provocative exercise tests and detailed imaging are also necessary to identify those in need of intervention and establish most appropriate treatment. Provocative exercise tests and duplex imaging can then be used to confirm flow limitation before detailed assessment of abnormal anatomy with MRA and DSA. These multiple imaging modalities are necessary to identify those most likely to benefit from surgery and clarify whether each patient should undergo arterial release, vessel shortening, endofibrosectomy or interposition grafting. 4
34. Wallin D, Yaghoubian A, Rosing D, Walot I, Chauvapun J, de Virgilio C. Computed tomographic angiography as the primary diagnostic modality in penetrating lower extremity vascular injuries: a level I trauma experience. Ann Vasc Surg. 2011;25(5):620-623. Review/Other-Dx 132 patients To perform a retrospective review of all patients presenting with penetrating lower extremity trauma between 2008 and 2009. There were 132 patients with penetrating lower extremity trauma. The average age of the patients was 25 years, with an average injury severity score of 10. The injuries were primarily gunshot wounds (89%). In all, 59 patients (45%) underwent CTA. CTA of the extremity was performed as a continuation of a computed tomography of the chest/abdomen/pelvis in 28 (47%) versus a targeted CTA of the extremity in 31 (53%) patients. In all, 34 (58%) CTAs were negative for vascular injury, 19 (32%) were positive, and six (10%) were indeterminate. Of the 34 patients with a normal CTA, none went to the operating room for repair of a major vascular injury; similarly, of the 19 patients with an abnormal CTA, there were no negative operative explorations. A total of 28 (21%) patients required operative intervention for the injured extremity; procedures performed included fasciotomy, venous and arterial ligation, primary repair, and interposition grafting. There were no amputations and no mortalities. 4
35. Bas A, Dikici AS, Gulsen F, et al. Corkscrew Collateral Vessels in Buerger Disease: Vasa Vasorum or Vasa Nervorum. J Vasc Interv Radiol. 2016;27(5):735-739. Review/Other-Dx 10 patients To investigate the origin of "corkscrew" collateral vessels around the occluded popliteal artery in patients with Buerger disease by Doppler ultrasound (US) and magnetic resonance (MR) imaging in tandem with digital subtraction angiography (DSA). Ten patients with occlusion of the popliteal artery were selected for inclusion, and 12 lower limbs of these patients were investigated. The study cohort comprised one woman and nine men with a mean age of 41 years ± 10 (standard deviation; range, 39-58 y). Corkscrew collateral vessels identified on DSA examinations were also identified on secondary imaging (Doppler US and MR imaging) in all patients except one in whom the popliteal artery was reconstituted after short-segment occlusion. The origin of the corkscrew collateral vessels was identified as the vasa nervorum of the tibial nerve in nine patients. 4
36. Blondin D, Lanzman R, Schellhammer F, et al. Fibromuscular dysplasia in living renal donors: still a challenge to computed tomographic angiography. Eur J Radiol. 2010;75(1):67-71. Review/Other-Dx 101 patients To determine the incidence of Fibromuscular dysplasia in our population and the reliability of computed tomography angiography for detecting vascular pathology. Four cases of fibromuscular dysplasia (incidence 3.9%) in 101 renal donors were diagnosed by transplanting surgeons and histopathology, respectively. Three cases could be detected by CTA. In one donor even retrospective analysis of CTA was negative. Ten accessory arteries, 14 venous anomalies and 12 renal arteries stenosis due to atherosclerosis were diagnosed by CTA and could be confirmed by the operative report. 4
37. Bolen MA, Brinza E, Renapurkar RD, Kim ESH, Gornik HL. Screening CT Angiography of the Aorta, Visceral Branch Vessels, and Pelvic Arteries in Fibromuscular Dysplasia. JACC Cardiovasc Imaging. 10(5):554-561, 2017 05. Review/Other-Dx 113 patients To evaluate the diagnostic yield of a dedicated computed tomography angiography (CTA) protocol of the chest, abdomen, and pelvis in patients with fibromuscular dysplasia (FMD). Abnormalities including beading, aneurysm, dissection, and stenosis/occlusion were noted in aortic, renal, mesenteric, and iliac distributions. The most commonly affected vessels were the renal arteries (n = 76 [67%]), followed by the lower extremity/iliac arteries (n = 37 [32%]). Aortic abnormalities were less frequently encountered (n = 3 [3%]), including 1 case with mild dilation (4.2 cm) of the ascending aorta and 2 cases of dissection involving the descending aorta, 1 with mild dilation (4.4 cm). Incremental findings beyond those known at patient intake were commonly noted, including new areas of arterial beading (n = 55 [49%]), new aneurysms (n = 21 [19%]), and new dissections (n = 3 [3%]). Reformatted images were crucial, affecting final assessment in 56% of cases evaluated by reader 1 and 36% evaluated by reader 2. 4
38. Meuse MA, Turba UC, Sabri SS, et al. Treatment of renal artery fibromuscular dysplasia. Tech Vasc Interv Radiol. 2010;13(2):126-133. Review/Other-Dx N/A To focus on the modern technical considerations in the diagnostic evaluation and endovascular treatment of renal artery fibromuscular dysplasia. No results stated in abstract 4
39. Mousa AY, Campbell JE, Stone PA, Broce M, Bates MC, AbuRahma AF. Short- and long-term outcomes of percutaneous transluminal angioplasty/stenting of renal fibromuscular dysplasia over a ten-year period. J Vasc Surg. 2012;55(2):421-427. Observational-Tx 35 patients; 43 procedures To evaluate short and long-term outcomes of percutaneous transluminal intervention in patients with symptomatic renal artery stenosis due to fibromuscular dysplasia (RAFMD) and/or the combination of RAFMD with aorto-ostial atherosclerotic disease. Forty-three procedures were performed on 35 patients with RAFMD. Thirty-two patients (91%) were women, with mean age of 61.9 years old. Technical success was 100% with adjunctive stent placement required in the FMD segment for dissection in 1 patient (2.3%) and in the non-FMD aorto-ostial atherosclerotic lesion in 4 patients (9.3%). Short-term outcomes: the majority (69%) had an immediate clinical benefit for hypertension, 6% were cured without BP medications, and 63% improved with less than or equal to preoperative BP medications. Postintervention, 17% remained at moderately reduced renal function (<60), whereas the percent above >60 mL/minute eGFR increased significantly (from 51% to 69%; P = .002). For the entire cohort, renal function (mean eGFR) significantly increased from 71.9 mL/minute + 5.8 to 80.8 mL/minute + 5.2 (P = .007). Long-term outcomes: freedom from recurrent or worsening hypertension (>140 systolic blood pressure [SBP] and >90 diastolic blood pressure [DBP]) was (93%, 75%, and 41%) and freedom from reduced renal function (eGFR <30 mL/minute) was (100%, 95%, and 64%) at 1, 5, and 8 years, respectively. Patients with reduced baseline renal function (<60 mL/minute) and combined atherosclerotic disease were more likely to experience long-term reduced renal function (eGFR <30 mL/minute; P = .003). Primary and assisted primary patency was (95%, 71%, and 50%) and (100%, 100%, and 100%) at 1, 5, and 9 years, respectively. 2
40. Sabharwal R, Vladica P, Coleman P. Multidetector spiral CT renal angiography in the diagnosis of renal artery fibromuscular dysplasia. Eur J Radiol. 2007;61(3):520-527. Observational-Dx 21 patients To evaluate the role and detection rate of multidetector spiral computed tomography angiography as compared with conventional angiography, the commonly accepted gold standard, in the diagnosis of renal artery fibromuscular dysplasia. Mean patient age was 62.33+14.32 years (range 24-85 years). CTA identified all 42 main renal arteries (100%) and all 10 accessory renal arteries (100%) visualized on CA. In the diagnosis of FMD, CTA detected all 40 (100%) lesions detected by CA. No single CTA reconstruction technique was able to detect all lesions noted on corresponding CA, however, upon review of all CTA reconstructions (MPR, MIP and SSD) in each case, every lesion was correctly identified by CTA. 2
41. Mousa AY, Gill G. Renal fibromuscular dysplasia. [Review]. Semin Vasc Surg. 26(4):213-8, 2013 Dec. Review/Other-Tx N/A To provide the clinician with a base understanding of available evidence for diagnosing and treating renal artery fibromuscular dysplasia. No results stated in abstract 4
42. Watchorn J, Miles R, Moore N. The role of CT angiography in military trauma. Clin Radiol. 68(1):39-46, 2013 Jan. Review/Other-Dx 144 patients To review whole-body computed tomography (CT) angiography as an unmatched way of fully assessing battle-injured patients, and the prevalence of vascular, predominantly arterial, injuries identified. One hundred and forty-four patients underwent whole-body CT of which 17% had an occult vascular injury on CT. Twenty of these injuries (56%) were in the lower limbs, excluding extravasation at the site of amputation. Improvised explosive devices (IEDs) accounted for 71% (180 of 253) of battle injuries. The median time from admission to CT was 28 min. An additional 12% longer per patient is taken on average in a multiple casualty incident. Including contrast medium administration, whole-body angiography is completed in less than 2 min (mean 116 s). 4
43. Patterson BO, Holt PJ, Cleanthis M, et al. Imaging vascular trauma. [Review]. Br J Surg. 99(4):494-505, 2012 Apr. Review/Other-Dx 10 patients; 58 articles To define optimal first-line imaging in patients with suspected vascular injury in different anatomical regions. Of 1,511 titles identified, 58 articles were incorporated in the systematic review. Most described the use of CTA. The application of duplex US, MRI/angiography and transesophageal echocardiography was described, but significant drawbacks were highlighted for each. CTA displayed acceptable sensitivity and specificity for diagnosing vascular trauma in blunt and penetrating vascular injury within the neck and extremity, as well as for blunt aortic injury. 4
44. Feliciano DV, Moore FA, Moore EE, et al. Evaluation and management of peripheral vascular injury. Part 1. Western Trauma Association/critical decisions in trauma. J Trauma 2011;70:1551-6. Review/Other-Dx N/A To present an algorithm that emphasizes evaluation, diagnosis, and need for operation versus a therapeutic procedure performed in interventional radiology. Peripheral vascular injures defined as axillobrachial and branches in the upper extremity and femoropopliteal and branches in the lower extremity account for 40% to 75% of all vascular injuries treated in civilian trauma centers. With the exception of the axillary artery, the long tracks of named arteries and veins in the extremities make them particularly susceptible to either penetrating or blunt trauma. This fact coupled with the smaller diameter of many of these vessels (as compared with those in the thorax or abdomen) and the ability of the patient and others to control external hemorrhage with compression contribute to a low incidence of death in the field. 4
45. Wahlgren CM, Riddez L. Penetrating Vascular Trauma of the Upper and Lower Limbs. Current Trauma Reports 2016;2:11-20. Review/Other-Tx N/A To focus on the specific management of penetrating vascular injuries in the upper and lower limbs. No results stated in abstract. 4
46. deSouza IS, Benabbas R, McKee S, et al. Accuracy of Physical Examination, Ankle-Brachial Index, and Ultrasonography in the Diagnosis of Arterial Injury in Patients With Penetrating Extremity Trauma: A Systematic Review and Meta-analysis. [Review]. Academic Emergency Medicine. 24(8):994-1017, 2017 08. Meta-analysis 8 Studies To determine the utility of physical examination, Ankle-Brachial Index (ABI), and Ultrasonography (US) in the diagnosis of arterial injury in emergency department (ED) patients who have sustained PET We included eight studies (n = 2,161, arterial injury prevalence = 15.5%). Studies had variable quality with most at high risk for partial and double verification bias. Some studies investigated multiple index tests: physical examination (hard signs) in three studies (n = 1,170), ABI in five studies (n = 1,040), and US in four studies (n = 173). Due to high heterogeneity (I(2) > 75%) of the results, we could not calculate LR+ or LR- for hard signs or LR+ for ABI. The weighted prevalence of arterial injury for ABI was 14.3% and LR- was 0.59 (95% confidence interval [CI] = 0.48-0.71) resulting in a posttest probability of 9% for arterial injury. Ultrasonography had weighted prevalence of 18.9%, LR+ of 35.4 (95% CI = 8.3-151), and LR- of 0.24 (95% CI = 0.08-0.72); posttest probabilities for arterial injury were 89% and 5% after positive or negative US, respectively. The posttest probability of arterial injury with positive US (89%) exceeded the CTA treatment threshold (72.9%). The posttest probabilities of arterial injury with negative US (5%) and normal ABI (9%) exceeded the CTA testing threshold (0.14%). Normal examination (no hard or soft signs) with normal ABI in combination had LR- of 0.01 (95% CI = 0.0-0.10) resulting in an arterial injury posttest probability of 0%. Good
47. American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: https://edge.sitecorecloud.io/americancoldf5f-acrorgf92a-productioncb02-3650/media/ACR/Files/Clinical/Appropriateness-Criteria/ACR-Appropriateness-Criteria-Radiation-Dose-Assessment-Introduction.pdf. Review/Other-Dx N/A To provide evidence-based guidelines on exposure of patients to ionizing radiation. No abstract available. 4
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