Do not stent a stenotic renal artery unless there is refractory hypertension or declining renal function.
Renal artery stenting requires excellent expertise because it may cause rupture, dissection or thrombosis of the artery. Furthermore, there is no difference between best medical treatment and stenting, according to recent studies.
Do not perform open or endovascular treatment of lower limb lesions unless there is disabling claudication, critical limb ischemia or diabetic foot.
Treating a stenotic or occluded artery of the lower limbs that does not cause symptoms is inappropriate. There is no evidence that such a treatment would improve the evolution of the disease. Any treatment may expose the patient to the risk of relapse, often with a...
Do not request a Duplex scan of the carotid arteries for vertigo, tinnitus, headache, neck pain, unless there are neurologic signs.
Symptoms of cerebrovascular insufficiency are often confused with those of other diseases. Furthermore, the term Transient Ischemic Attack (TIA) is often used inappropriately. It should be reserved only for a sudden, focal neurologic attack lasting less than 24 hours,...
Do not request a Duplex scan as a first level test for lower limb arterial disease, in patients that are asymptomatic or with mild claudication. Measure instead the Ankle Brachial Index (ABI).
Duplex scan is often requested for paresthesias with palpable distal pulses. ABI measurement is adequate to diagnose arterial disease and start treatment. If the symptoms are severe the patient can be sent to the vascular surgeon. Following this recommendation would...The campaign DOING MORE DOES NOT MEAN DOING BETTER – CHOOSING WISELY ITALY is promoted by Italy’s Slow Medicine
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