CAROTID ARTERY - STENOSIS
For stenosis of <60% with ICA PSV < 175 cm/sec, f/u at 24 months (if then).
For stenosis of <60% with ICA PSV >175 cm/sec, f/u at six month intervals.Vascular referral for stenosis of >50% in men and >70% in women.
Lovelace TD et al. Optimizing duplex follow-up in patients with an asymptomatic internal carotid artery stenosis of less than 60%. J Vasc Surg 2001;33:56-61.
INTRACRANIAL VESSELS - ANEURYSM
Asymptomatic aneurysms of > 7 mm: vascular referral.Asymptomatic aneurysms of < 7 mm: six month, then annual (for 3 years) then every other year follow-up with CTA or MRA.
Singer RJ et al. Unruptured intracranial aneurysms. UpToDate, accessed 1/1/16.
ABDOMINAL AORTA - ANEURYSM
See Table 1. Recommendations for follow-up and further immediate evaluation vary with size and are contained in the macro “follow up aortic aneurysm” in the form of an enforced pick list.
AORTA - PENETRATING ATHEROSCLEROTIC ULCER
Annual follow-up for asymptomatic penetrating atherosclerotic ulcers, although it does state that it may be difficult to tell whether nonspecific chest and/or abdomen pain is coming from such ulcers.
SPLENIC ARTERY - ANEURYSM
Annual follow-up of splenic artery aneurysms less than 20 mm, and vascular consult for aneurysms of greater than 20 mm. These are in the macro “follow up splenic aneurysm”.
ILIAC ARTERY - ANEURYSM
No specific treatment or follow-up for asymptomatic iliac artery aneurysms of less than 30 mm, initial six month then annual follow-up of aneurysms 30-35 mm, and vascular consult for aneurysms of greater than 35 mm. These are in the macro “follow up iliac aneurysm”.
RENAL ARTERY - ANEURYSM
Annual follow-up of renal artery aneurysms measuring 10 to 15 mm in nonhypertensive patients, and vascular consult for aneurysms of greater than 20 mm in nonhypertensive, and 15 mm in hypertensive patients. These are in the macro “follow up splenic aneurysm”.
OTHER ASYMPTOMATIC VASCULAR LESIONS
Other asymptomatic lesions (if genuinely asymptomatic) require no further work up, follow up, or treatment. These include thrombi in the cava, a flat cava, May Thurner (iliocaval compression) syndrome, compression of the left renal vein between the aorta and SMA with varices (nutcracker syndrome), and dilated pelvic veins.
Khosa F et al. Managing incidental findings on abdominal and pelvic CT and MR: part 2: white paper of the ACR incidental findings committee II on vascular findings. J Am Coll Radiol 2013;10:789-794.
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Radiology Associates of the Fox Valley
THORACIC AORTA - ANEURYSM
For aneurysms greater than 40-55 mm: repeat study in 6 months to document stability; if stable, annual studies thereafter for 35 – 44 mm aneurysms and every six months for aneurysm 45-54 mm. Vascular consult for aneurysms > 55 mm or those with a growth rate of > 5 mm/yr.
Hiratzka LF et al. ACCF – SVM guidelines for the diagnosis and management of patients with thoracic aortic disease: executive summary. J Am Coll Cardiol 2010;55:1509-1544.