Choosing Wisely

Five Things Physicians and Patients Should Question in Vascular Medicine

As part of the Choosing Wisely campaign, the Society for Vascular Medicine has created a list of five tests and procedures that are commonly used but are at times unnecessary or even harmful. SVM recommends that physicians and patients carefully consider and openly discuss these before incorporating them into a treatment plan. Download a two-page PDF.

Five Things Physicians and Patients Should Question
in Vascular Medicine

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.

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.

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.

Refrain from percutaneous or surgical revascularization of peripheral artery stenosis in patients without claudication or critical limb 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.

Don’t screen for renal artery stenosis in patients without resistant hypertension and with normal renal function, even if known atherosclerosis is present.
Performing surgery or angioplasty to improve circulation to the kidneys has no proven preventive benefit, and shouldn’t be considered unless there is evidence of symptoms, such as elevated blood pressure or decreased renal function.

As in every field of medicine, there are certain procedures in vascular medicine that physicians and patients should question. Choosing Wisely promotes conversations between physicians and patients about what care is appropriate for their condition—thus avoiding unnecessary tests and procedures.

The list developed by SVM will help promote conversations between physicians and patients about utilizing the most appropriate tests and treatments, and avoiding care whose potential harm may outweigh the benefits.

SVM brings valuable expertise and focus on vascular medicine care to the campaign as well as a trusted voice in reaching our 500+ members, and in turn, their patients.

Each society determined the process for creating its lists.

SVM developed its list using the most current evidence about management and treatment options within our areas of expertise.
The list provides targeted, evidence-based interventions to help vascular medicine physicians and patients have conversations about making wise choices about their care to avoid inappropriate tests or procedures that provide little to no benefit.

The list was developed over the last year after careful consideration of the latest evidence, expert opinions and research. 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 email, and a second email 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.

The Choosing Wisely recommendations come from physicians in specialty societies, using the most current evidence about management and treatment options within their areas of expertise. The ABIM Foundation led the organization of the campaign, but the recommendations are from the specialty societies.

The lists provide targeted, evidence-based interventions to help physicians and patients have conversations about making wise choice about their care to avoid inappropriate tests or produces that provide no benefit.

Choosing Wisely is part of a multi-year effort led by the ABIM Foundation to support and engage physicians in being better stewards of finite health care resources. It is part of the ABIM Foundation’s long history of advancing medical professionalism and supporting similar initiatives.

Medical Professionalism in the New Millennium: A Physician Charter, authored in 2002 by the ABIM Foundation, American College of Physicians Foundation and European Federation of Internal Medicine, articulates the professional responsibilities of physicians to, amongst other things, advocate for a just distribution of finite resources.

Choosing Wisely was created by work conducted by the National Physicians Alliance (NPA) through an ABIM Foundation grant. NPA’s Promoting Good Stewardship in Clinical Practice project resulted in a set of three lists of specific steps physicians in internal medicine, family medicine and pediatrics could take in their practices to promote the more effective use of health care resources. These lists were published in Archives of Internal Medicine.

Since Choosing Wisely’s launch in April 2012, hundreds of millions of consumers, physicians and stakeholders have begun to have important conversations about unnecessary tests and procedure

According to a recent report from the Institute of Medicine, up to 30 percent of health care delivered in the United States is duplicative or unnecessary. Providers and economists agree that this is unsustainable and threatens America’s ability to provide the highest quality of care possible to all patients.

Learn more about Choosing Wisely at www.choosingwisely.org.