Table I.
Working guidelines for vascular procedures and other services
| Disease | Description | Intended procedure(s) | Recommendation |
|---|---|---|---|
| Limb/visceral ischemia | |||
| ALI | Deteriorating sensory/motor function Tissue loss Dry/wet gangrene, ascending cellulitis Compartment syndrome |
Fasciotomy Embolectomy Catheter-directed thrombolysis Peripheral angiogram Endovascular therapy Surgical revascularization Amputation |
Must do |
| Vascular injury | Bleeding/expanding hematoma/hemodynamic derangement/potential life/limb loss situation | Hemostasis/vascular repair | Must do |
| CLI | CLTI—rest pain | Peripheral angiogram Endovascular therapy Surgical revascularization |
Consider aggressive medical management instead |
| CLTI—tissue loss | Peripheral angiogram Endovascular therapy Surgical revascularization Amputation |
Must do | |
| Intermittent claudication | Peripheral angiogram and endovascular therapy | Should be deferred | |
| Mesenteric vascular ischemia | Stable | Visceral angiogram and endovascular therapy | Should be deferred |
| Disabling symptoms | Visceral angiogram and endovascular therapy | Consider deferral/consider aggressive medical management instead | |
| TOS | Arterial/venous | Surgery | Consider deferral |
| Neurogenic | Surgery | Should be deferred | |
| Arterial aneurysm/dissection | |||
| Arterial aneurysm | Stable, not rapidly increasing in size | Repair by surgical/endovascular means | Should be deferred |
| Stable but rapidly increasing in size/ruptured/impending rupture (clinical/Doppler/CT/angiographic evidence) | Repair by surgical/endovascular means | Should not be deferred | |
| AAA/TAAA/aortic dissection | Stable, not rapidly increasing in size (clinical/Doppler/CT/angiographic evidence) | Repair by surgical/endovascular means | Should be deferred |
| Stable but rapidly increasing in size/ruptured/impending rupture (clinical/Doppler/angiographic evidence) | Repair by surgical/endovascular means | Should not be deferred | |
| Carotid atherosclerotic disease | |||
| Carotid atherosclerotic disease | Stable, asymptomatic, mild to moderate symptoms | Duplex evaluation | Should be deferred/consider aggressive medical management instead |
| Moderate to severe symptoms directly attributable to carotid pathology | Duplex evaluation/DSA/CAS/CEA | Consider deferral/consider aggressive medical management instead | |
| Venous diseases | |||
| Acute DVT | Iliofemoral with phlegmasia | Thrombolysis/medical management | Consider aggressive medical management instead |
| Femoropopliteal | Thrombolysis/medical management | Consider aggressive medical management instead | |
| High risk of PE | IVC filter insertion/removal | Consider deferral | |
| Chronic DVT/PTS | Swelling/blackening/ulcer | Venous intervention | Should be deferred/consider aggressive medical management instead |
| Varicose vein | C0–C5 | Medical management/surgery/EVLA/RFA | Should be deferred |
| C6 | Medical management/surgery/EVLA/RFA | Should be deferred/consider aggressive medical management instead | |
| Hemodialysis access | |||
| AVF | ESRD with no other means of HD | Elective creation of AVF/tunneled catheter | Should not be deferred |
| ESRD having other means of HD | Elective creation of AVF/tunneled catheter | Should be deferred | |
| ESRD with access complications (thrombosis/infection/pseudoaneurysm/bleeding) | Surgical correction | Should not be deferred | |
| ESRD with failing AVF with no other means of HD | Fistulogram/fistuloplasty | Should not be deferred | |
| ESRD with failing/failed AVF with other available means of HD | Fistulogram/fistuloplasty | Should be deferred | |
| Vascular malformations | |||
| AVM | Arterial/venous with major bleeding | Surgical/endovascular hemostasis (e.g., embolization) | Should not be deferred |
| Vascular outpatient services | |||
| Vascular duplex study | Should be deferred (unless deemed mandatory for evaluation of urgent cases) | ||
| OPD | Should be deferred (encourage telemedicine) | ||
AAA, abdominal aortic aneurysm; ALI, acute limb ischemia; AVF, arteriovenous fistula; AVM, arteriovenous malformation; CAS, carotid artery stenting; CEA, carotid endarterectomy; CLI, chronic limb ischemia; CLTI, chronic limb-threatening ischemia; CT, computed tomography; DSA, digital subtraction angiography; DVT, deep vein thrombosis; ESRD, end-stage renal disease; HD, hemodialysis; OPD, outpatient department; TAAA, thoracoabdominal aortic aneurysm; TOS, thoracic outlet syndrome; PTS, post thrombotic syndrome; IVC, inferior vena cava; EVLA, endovenous laser ablation; RFA, radio frequency ablation.