ACC/AHA/SCAI/SIR/SVM 2018 Appropriate Use Criteria for Peripheral Artery Intervention: A Report of the American College of Cardiology Appropriate Use Criteria Task Force, American Heart Association, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, and Society for Vascular Medicine

According to the ACC/AHA 2005 Guidelines for the Management of Patients with Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic) (7), a viable kidney is defined as having a pole-to-pole linear length >7 cm.5 Abbreviations AUC = Appropriate Use Criteria CLI = critical limb ischemia PAD = peripheral artery disease PAI = peripheral artery intervention RAS = renal artery stenosis SFA = superficial femoral artery 6 Peripheral Artery Intervention Appropriate Use Criteria (By Indication) The final ratings for PAI are listed by indication in Tables 1.1 to 6.3. [...]patients with moderate RAS (50% to 69% diameter stenosis) with translesional gradients that fail to achieve the threshold are considered Rarely Appropriate for renal stenting (19).Section 2 Lower Extremity Disease Section 2 Results and Discussion The AUC recommendations for lower extremity revascularization in patients with claudication are based on expert consensus statements most recently summarized in the 2016 AHA/ACC Guideline on the Management of Patients with Lower Extremity Peripheral Artery Disease (4). Angiographic presence of an intermediate-severity stenosis may not indicate a hemodynamically significant, symptom-inducing lesion. [...]physiological assessments demonstrating a significant flow limitation with segmental Doppler pressures, exercise ankle-brachial index testing, and/or measurement of translesional gradients are essential in selecting patients who will benefit from revascularization. [...]the AUC provide physician-driven and peer-reviewed recommendations that may reduce administrative controls or government regulation if proven to be effective in reducing Rarely Appropriate revascularizations.8 Conclusion This AUC report provides a guide for clinicians in determining the role of different revascularization options in the care of patients with PAD.