ACCF/ACR/AIUM/ASE/IAC/SCAI/SCVS/SIR/SVM/SVS/SVU 2013 Appropriate Use Criteria for Peripheral Vascular Ultrasound and Physiological Testing Part II

Testing for Venous Disease and Evaluation of Hemodialysis Access

Heather L. Gornik, MD, FACC, FAHA, FSVM; Marie D. Gerhard-Herman, MD, FACC; Sanjay Misra, MD, FSIR, FAHAz; Emile R. Mohler III, MD, FACC; R. Eugene Zierler, MD, FACS; Reza Fazel, MD, MS; Laura Findeiss, MD, FSIR; Richard Fuchs, MD, FACC, FAHA; John Gillespie, MD; John Gocke, MD, MPH, RVT, RPVI; Michael H. Heggeness, MD, PHD; Joseph P. Hughes, RVT, RCS, FSVU; Michael P. Lilly, MD; Colleen Moore, MD; John S. Pellerito, MD, FACR, FSRU, FAIUM; Michelle L. Robbin, MD, FACR, FSRU, FAIUM; Thom W. Rooke, MD; Melvin Rosenblatt, MD; Fred A. Weaver, MD, MMM, FACS; Christopher J. White, MD; Michael J. Wolk, MD, MACC; Steven R. Bailey, MD, FACC, FSCAI, FAHA; John U. Doherty, MD, FACC, FAHA; Pamela S. Douglas, MD, MACC, FAHA, FASE Z; Jenissa Haidari, MPH; Robert C. Hendel, MD, FACC, FAHA, FASNC; Christopher M. Kramer, MD, FACC, FAHA; James K. Min, MD, FACC; Manesh R. Patel, MD, FACC; Leslee Shaw, PHD, FACC, FASNC; Raymond F. Stainback, MD, FACC, FASE; Joseph M. Allen, MA; Heather L. Gornik, MD, FACC, FAHA; Michael J. Wolk, MD, MACC


J Am Coll Cardiol. 2013;62(7):649-665. 

In This Article

1 Introduction

Improvements in cardiovascular imaging technology and their application, coupled with increasing therapeutic options for cardiovascular disease, have led to an increase in cardiovascular imaging. Diagnostic imaging services reimbursed under Medicare's physician fee schedule grew more rapidly than any other type of physician service from 1999 to 2003, although more recently, the rate of imaging volume growth in Medicare has been slowing. Still, the armamentarium of noninvasive diagnostic tools has expanded greatly, offering a variety of new and more sophisticated imaging techniques. As imaging technology and clinical applications continue to advance, the healthcare community needs to understand how to best incorporate these technologies into daily clinical care and how to choose between new and long-standing established imaging technologies. In an effort to respond to this need and to ensure the effective use of advanced diagnostic imaging tools, the Appropriate Use Criteria (AUC) project was initiated. This document serves as the second in a 2-part series evaluating noninvasive testing for peripheral vascular disorders with ultrasound and physiological testing. The focus of this document is clinical indications associated with evaluation of the venous system as well as preparation for and evaluation of dialysis access (e.g., arteriovenous fistulas). Appropriate use criteria for evaluation of peripheral arterial disorders (carotid, lower and upper extremities, abdominal aorta, visceral artery) have been previously published.[1] The indications and findings from this AUC process are meant to help inform and ensure the highest quality and most efficient use of vascular laboratory testing (vascular ultrasound and physiological testing) in the evaluation of the venous system.