In my involvement in ASE through the Vascular Council, I am energized by enthusiasm for integrating vascular imaging into cardiovascular practice. To provide the best care for our patients, we aim to promote quality and innovation in vascular assessment through our educational and research activities. In this council communication, I will give an update about vascular imaging at the ASE Scientific Sessions and recent developments in arterial evaluation.
Vascular Imaging at the ASE Scientific Sessions: Past and Future
There was considerable growth in the vascular imaging activities at the 23 rd Annual Scientific Sessions held in June at the Gaylord Hotel in National Harbor, MD. We had a full day of dedicated vascular programming on Monday that started with our annual Vascular Council business meeting. We expanded on the annual vascular travel grant program by including both a sonographer and a physician awardee. The sonographer award went to Suzanne Poston, RDCS, FASE from the University of Texas in Houston, and the physician award to Rene Quiroz, MD from Boston University School of Medicine. Dr. Quiroz presented a case of a patient with Behcet’s disease and a popliteal artery aneurysm. Both awardees reviewed their experiences in the council communication in September. In addition, we presented the award for the best vascular disease abstract to Ingrid Hriljac, MD from Cornell Medical College for her work entitled “Prevalence and Clinical Correlates of Popliteal Artery Atherosclerosis in Young Adults: The Strong Heart Study.”
The business meeting was followed by vascular imaging talks with a concentration on carotid imaging. We persevered through a venue change as the power was lost for a few hours in the entire National Harbor area. A special thanks to Sherif Nagueh, MD, FASE who made sure we could continue our sessions, with images, during this time on a back-up generator. We were all truly impressed by the dedication of the ASE staff and the conference attendees, who showed the same active interest even in adverse circumstances. The talks and audience participation were amazing.
The 24 th annual Scientific Sessions will be held in Minneapolis from June 29 through July 2, 2013. Based on interest of the council membership, we are going to continue the theme of carotid imaging. The emphasis this year will be on bringing together imaging with disease management. Talks will include updates on quality control, imaging challenges, vertebral disease and cardiac-vascular connections.
Developments in Arterial Assessment
A key component of the vascular laboratory is the evaluation of arterial physiology. Two recent documents update the performance and use of arterial testing in practice.
Ankle-Brachial Index: Measurement and Interpretation of the Ankle-Brachial Index: A Scientific Statement from the American Heart Association was released in November 2012. Evaluation of lower extremity arterial disease by assessing arm and leg blood pressures has been performed for more than 50 years. However, the technique is not consistent across laboratories. Also, evidence is building about the value of measuring ABI to determine cardiovascular risk. The statement includes a comprehensive review of studies about the diagnostic and predictive value of resting and exercise ABIs. Specific recommendations include using Doppler to measure pressures in both arms. The ABI should be calculated as the higher of the posterior tibial or dorsalis pedis pressure (in the absence of non-compressible vessels) divided by the higher of the two arm pressures. For a diagnostic study, both legs should be reported. For a prognostic study, the lower ABI is used. Consistent with the recent PAD guidelines, the cutoff for diagnosis of PAD is ≤0.90 with normal defined as 1.0 to 1.4 and borderline 0.91 to 0.99. Non-compressible vessels are ABI >1.4. The full text of the document is available at: .
Appropriate Use Criteria: 2012 Appropriate Use Criteria for Peripheral Vascular Ultrasound and Physiological Testing Part I: Arterial Ultrasound and Physiological Testing was published in July 2012. The ASE, including many current and former members of the Vascular Council Board, participated in the generation of the first appropriate use criteria for arterial testing. The document covers arterial ultrasound in all vascular beds and physiologic testing. Overall, arterial testing was determined to be appropriate in roughly half of the clinical situations. In general, vascular studies were usually categorized as appropriate to evaluate patient symptoms. To focus on the arterial testing piece, there are tables that delineate appropriate clinical indications for performing arterial physiological testing for diagnosing and following lower extremity PAD. The use of ABI alone to screen for atherosclerotic disease was also deemed appropriate for select patient groups including patients age >50 with diabetes or history of smoking or patients age >70. We will have a talk discussing the entire document during the ASE Scientific Sessions. The full text of the document is available at: content.onlinejacc.org/article.aspx?articleid=1216177 .
We look forward to seeing you all in Minneapolis in June! We encourage you to participate in council activities, and to use the council community at Connet at asecho.org to give us feedback, suggestions, and questions.