Society for Vascular Medicine

Five Things Physicians and Patients Should Question

Released February 21, 2013; Update June 16, 2022

  1. 1

    Don’t do work up for clotting disorder (order hypercoagulable testing) for patients who develop first episode of deep vein thrombosis (DVT) in the setting of a known cause.

    Lab tests to look for a clotting disorder will not alter treatment of a venous blood clot, even if an abnormality is found. DVT is a very common disorder, and recent discoveries of clotting abnormalities have led to increased testing without proven benefit.

  2. 2

    Don’t reimage DVT in the absence of a clinical change.

    Repeat ultrasound images to evaluate “response” of venous clot to therapy does not alter treatment.

  3. 3

    Avoid cardiovascular testing for patients undergoing low-risk surgery.

    Pre-operative stress testing does not alter therapy or decision-making in patients facing low-risk surgery.

  4. 4

    Refrain from revascularization of peripheral artery disease in patients without lifestyle-limiting claudication or critical limb ischemia/chronic limb-threatening ischemia.

    Patients without symptoms will not benefit from attempts to improve circulation. No evidence exists to support improving circulation to prevent progression of disease. There is no proven preventive benefit, only symptomatic benefit.

  5. 5

    Don’t screen for atherosclerotic renal artery stenosis in patients without resistant or accelerating hypertension, cardiac disturbance syndromes or rapidly deteriorating renal function.

    The only situations where treating renal artery stenosis may offer benefit is in patients with accelerating hypertension on maximal medical therapy, acute pulmonary edema without a cardiac cause, or rapidly deteriorating renal function.

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

The Society for Vascular Medicine (SVM) is a nonprofit medical society comprised of physicians, surgeons, nurses, physician assistants, nurse practitioners, and vascular interventionists. For nearly 25 years, one of the goals of the Society has been to maintain high standards of clinical vascular medicine. The Society believes that optimal vascular care is best accomplished by the collegial interaction of a community of vascular professionals working with the patient. The Society recognizes the importance of individuals with diverse backgrounds in achieving ideal standards of research and clinical practice. The society believes that partnerships between patients and health care providers are crucial to improving vascular health, achieving better outcomes and lowering health care costs.

For more information, visit www.vascularmed.org.

How This List Was Created

The Society for Vascular Medicine (SVM) looked to the leadership of its Board of Trustees and input from its members to develop the list of five things physicians and patients should question. Suggestions from SVM members were solicited through an e-mail blast, and a second e-mail was sent to the SVM Board of Trustees seeking volunteers and suggestions.

A committee, consisting of four members of the Board of Trustees, narrowed an initial list down to seven recommendations. The full Board of Trustees voted on the recommendations using the Delphi method of choice, arriving at the five that became SVM’s list as part of the Choosing Wisely® campaign.

SVM’s disclosure and conflict of interest policy can be found at www.vascularmed.org.

Sources

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