A Comparative Study of Clinical Outcomes of Vascular Studies Performed Using Protocols from the American College of Radiology and the Intersocietal Commission for the Accreditation of Vascular Laboratories

Abstract

Introduction Confidence is placed in studies done in any vascular laboratory based on guidelines set forth by the accrediting body governing that service. Within the facilities of a newly formed health network, it was noted that vascular procedures were performed under the guidelines of two separate accrediting bodies. The larger of the two facilities is accredited by the Intersocietal Commission for the Accreditation of Vascular Laboratories (ICAVL) and the satellite facility is accredited by the American College of Radiology (ACR). Methods A comparative review of guidelines was done in an effort to establish “best practice” across the system. Between the two sets of imaging standards, the guidelines for obtaining images vary on lower extremity peripheral venous evaluations. In the exams, calf vein images are not performed under the ACR standards and are obtained under the ICAVL standards. Though not required under the ICAVL standards, it is considered best practice to image these patients during routine unilateral and bilateral exams. Due to the differences in practice between the two facilities, a retrospective chart review was conducted to evaluate clinical outcomes between the two groups of patients. Unilateral and bilateral lower extremity venous duplex examinations had been performed by vascular sonographers on all patients included in the chart review during a period of 12 months. Results Of the 1222 charts reviewed, 63 patients had positive findings of calf vein thrombosis under the ICAVL guidelines and would not have been diagnosed with ultrasound imaging alone under the ACR guidelines. Four patients who had been inpatients at the satellite facility were referred to the larger facility for follow-up care. A second venous duplex exam was performed due to persistence of symptoms. In these four patients that had follow-up exams, a negative interpretation was reported under the ACR guidelines, and a positive report for unilateral deep vein thrombosis in one or more of the calf veins (DVT) was given under the ICAVL guidelines. In another group of nine patients having follow-up procedures under both standards, contralateral comparison of the common femoral vein was not performed under the ACR guidelines. Using ICAVL guidelines, three of these patients were found to have nonphasic flow in the contralateral common femoral vein. Conclusions Such discrepancies have potential for negative clinical outcomes. The findings support the need for standardization of protocols between the two facilities by expansion of the ACR guidelines to include calf veins in the lower extremity venous evaluation. Further revision of the ACR standards is recommended, as well, to include imaging the contralateral common femoral vein in unilateral venous duplex exams in the lower extremity.