Is aortography abused in lower-limb iscaemia?

Area of Science:

• Vascular Surgery
• Diagnostic Imaging
• Health Services Research

Background:

• Aortography is a key diagnostic tool in vascular surgery.
• Assessing the appropriateness of aortography requests is crucial for efficient healthcare resource allocation.
• Previous studies have indicated variability in the utilization of diagnostic imaging procedures.

Purpose of the Study:

• To evaluate the justification and impact of aortography requests on patient management.
• To identify factors contributing to inappropriate or marginally valuable aortography requests.
• To propose guidelines for optimizing aortography utilization.

Main Methods:

• Retrospective review of 82 aortography requests from 1978 at a single hospital.
• Analysis of patient records to determine the justification for each aortography request.
• Categorization of requests into fully justified, inappropriate, or of marginal value.

Main Results:

• 49% of aortography requests were fully justified.
• 51% of requests were considered inappropriate (38%) or of marginal value (13%).
• No patients with unjustified aortograms underwent reconstructive surgery; reasons linked to clinical specialty and physician experience.

Conclusions:

• A significant proportion of aortograms were requested inappropriately or offered marginal value.
• Experienced medical staff should request aortography, exclusively when operative treatment is decided.
• A suggested algorithm can aid in judiciously deciding when to perform an aortogram.