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Rochon PJ, Reghunathan A, Kapoor BS, Kalva SP, Fidelman N, Majdalany BS, Abujudeh H, Caplin DM, Eldrup-Jorgensen J, Farsad K, Guimaraes MS, Gupta A, Higgins M, Kendi AT, Khilnani NM, Patel PJ, Dill KE, Hohenwalter EJ. ACR Appropriateness Criteria® Lower Extremity Chronic Venous Disease. J Am Coll Radiol 2023; 20:S481-S500. [PMID: 38040466 DOI: 10.1016/j.jacr.2023.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 08/22/2023] [Indexed: 12/03/2023]
Abstract
Lower extremity venous insufficiency is a chronic medical condition resulting from primary valvular incompetence or, less commonly, prior deep venous thrombosis or extrinsic venous obstruction. Lower extremity chronic venous disease has a high prevalence with a related socioeconomic burden. In the United States, over 11 million males and 22 million females 40 to 80 years of age have varicose veins, with over 2 million adults having advanced chronic venous disease. The high cost to the health care system is related to the recurrent nature of venous ulcerative disease, with total treatment costs estimated >$2.5 billion per year in the United States, with at least 20,556 individuals with newly diagnosed venous ulcers yearly. Various diagnostic and treatment strategies are in place for lower extremity chronic venous disease and are discussed in this document. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - Arun Reghunathan
- Research Author, University of Colorado Denver, Denver, Colorado
| | | | - Sanjeeva P Kalva
- Panel Chair, Massachusetts General Hospital, Boston, Massachusetts
| | - Nicholas Fidelman
- Panel Vice-Chair, University of California, San Francisco, San Francisco, California
| | - Bill S Majdalany
- Panel Vice-Chair, University of Vermont Medical Center, Burlington, Vermont
| | - Hani Abujudeh
- Detroit Medical Center, Tenet Healthcare and Envision Radiology Physician Services, Detroit, Michigan
| | - Drew M Caplin
- Zucker School of Medicine at Hofstra Northwell, Hempstead, New York
| | - Jens Eldrup-Jorgensen
- Tufts University School of Medicine, Boston, Massachusetts; Society for Vascular Surgery
| | | | | | - Amit Gupta
- Renaissance School of Medicine at Stony Brook University, Stony Brook, New York
| | | | - A Tuba Kendi
- Mayo Clinic, Rochester, Minnesota; Commission on Nuclear Medicine and Molecular Imaging
| | - Neil M Khilnani
- Weill Cornell Medicine-NewYork Presbyterian Hospital, New York, New York; American Vein and Lymphatic Society
| | - Parag J Patel
- Froedtert & The Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Karin E Dill
- Specialty Chair, Emory University Hospital, Atlanta, Georgia
| | - Eric J Hohenwalter
- Specialty Chair, Froedtert & The Medical College of Wisconsin, Milwaukee, Wisconsin
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Roberts PJJ, Ousey K, Barker C, Reel S. The role of podiatry in the early identification and prevention of lower limb venous disease: an ethnographic study. J Foot Ankle Res 2022; 15:84. [PMID: 36447219 PMCID: PMC9710130 DOI: 10.1186/s13047-022-00588-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 10/31/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Lower limb venous disease can cause significant pain, loss of mobility, and can be detrimental to an individual's quality of life. Manifestations of venous disease often pose a substantially negative impact on patients and place a high demand on finite healthcare resources. Whilst this problem is internationally recognised, most research and discourse has predominantly focussed on treatment of leg ulceration and prevention of recurrence. Prevention of lower limb venous disease progression to the first ulceration has received far less attention. Overall, the care of this condition appears to rest in the domain of medicine and nursing yet podiatry, a profession with responsibility for the lower limb and foot, is conspicuous by its absence from the literature. METHODS: An ethnographic approach was used to gather data from 26 participants through observation, semi-structured interviews, and a focus group interview. Qualitative analysis was conducted using the framework approach. RESULTS The findings revealed an identity crisis within the podiatry profession. Evidence emerged of ritual and routine practices that did not include lower limb venous disease. External control over practice limited the professional autonomy of podiatrists determining their own activities. Inter-professional relationships with nursing, and perceptions of boundaries that venous disease was a nursing role were also found to be limiting factors. CONCLUSIONS This research revealed that podiatry does not occupy a substantive role in contributing to the early identification and prevention of lower limb venous disease. Policy, education, research and practice changes are all required to enhance the contribution of podiatry to reduce the burden of this disease.
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Affiliation(s)
- Peter James Joseph Roberts
- grid.15751.370000 0001 0719 6059The University of Huddersfield, Queensgate, Huddersfield, HD1 3DH England
| | - Karen Ousey
- grid.15751.370000 0001 0719 6059The University of Huddersfield, Queensgate, Huddersfield, HD1 3DH England
| | - Caroline Barker
- grid.15751.370000 0001 0719 6059The University of Huddersfield, Queensgate, Huddersfield, HD1 3DH England
| | - Sarah Reel
- grid.15751.370000 0001 0719 6059The University of Huddersfield, Queensgate, Huddersfield, HD1 3DH England
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Khilnani NM, Meissner MH, Vedanatham S, Piazza G, Wasen SM, Lyden S, Schul M, Beckman JA. The evidence supporting treatment of reflux and obstruction in chronic venous disease. J Vasc Surg Venous Lymphat Disord 2018; 5:399-412. [PMID: 28411707 DOI: 10.1016/j.jvsv.2017.02.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 02/06/2017] [Indexed: 10/19/2022]
Abstract
On July 20, 2016, a Medicare Evidence Development and Coverage Advisory Committee panel convened to assess the evidence supporting treatment of chronic venous disease. Several societies addressed the questions posed to the panel. A multidisciplinary coalition, representing nine societies of venous specialists, reviewed the literature and presented a consensus opinion regarding the panel questions. The purpose of this paper is to present our coalition's consensus review of the literature and recommendations for chronic venous disease.
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Affiliation(s)
- Neil M Khilnani
- Division of Interventional Radiology, Weill Cornell Medicine Vein Treatment Center, NewYork-Presbyterian Hospital/Weill Cornell Medicine, New York, NY.
| | - Mark H Meissner
- Department of Surgery, University of Washington School of Medicine, Seattle, Wash
| | - Suresh Vedanatham
- Division of Interventional Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Mo
| | - Gregory Piazza
- Vascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Suman M Wasen
- Division of Vascular Medicine, Cardiovascular Section, University of Oklahoma College of Medicine, Oklahoma City, Okla
| | - Sean Lyden
- Department of Vascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | | | - Joshua A Beckman
- Vascular Medicine, Cardiovascular Division, Vanderbilt University Medical Center, Vanderbilt School of Medicine, Nashville, Tenn
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