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Home Lower Extremity Chronic Venous Disease
Variants
Scenario Scenario ID Procedure Adult RRL Peds RRL Appropriateness Category
Varicose veins, lower extremity, initial imaging 3196588
US duplex Doppler lower extremity
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
Catheter venography iliac veins
10-30 mSv
☢☢☢☢
Usually not appropriate
Catheter venography lower extremity
0.1-1mSv
☢☢
Usually not appropriate
CTV lower extremity with IV contrast
10-30 mSv
☢☢☢☢
Usually not appropriate
CTV pelvis with IV contrast
10-30 mSv
☢☢☢☢
Usually not appropriate
MRV lower extremity without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRV pelvis without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
US intravascular iliac veins
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
Scenario Scenario ID Procedure Adult RRL Peds RRL Appropriateness Category
Varicose veins, lower extremity, treatment 3196590
Compression therapy


Usually appropriate
Saphenous vein ablation


Usually appropriate
Compression sclerotherapy


Usually appropriate
Microphlebectomy


Usually appropriate
Ligation and stripping


May be appropriate
Scenario Scenario ID Procedure Adult RRL Peds RRL Appropriateness Category
Venous leg ulcer, lower extremity, initial imaging 3196592
US duplex Doppler lower extremity
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
US duplex Doppler IVC and iliac veins
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
CTV abdomen and pelvis with IV contrast
10-30 mSv
☢☢☢☢
May be appropriate
MRV abdomen and pelvis without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
Catheter venography iliac veins
10-30 mSv
☢☢☢☢
May be appropriate
CTV lower extremity with IV contrast
10-30 mSv
☢☢☢☢
May be appropriate
(Disagreement)
MRV lower extremity without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
(Disagreement)
US intravascular iliac veins
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
(Disagreement)
Catheter venography lower extremity
0.1-1mSv
☢☢
May be appropriate
Scenario Scenario ID Procedure Adult RRL Peds RRL Appropriateness Category
Venous leg ulcer, lower extremity, treatment 3196594
Wound care


Usually appropriate
Compression therapy


Usually appropriate
Saphenous vein ablation


Usually appropriate
Compression sclerotherapy


Usually appropriate
Iliac vein stenting


May be appropriate
Ligation and stripping


May be appropriate
Microphlebectomy


May be appropriate
Scenario Scenario ID Procedure Adult RRL Peds RRL Appropriateness Category
Varicose veins, lower extremity, pelvic origin suspected, initial imaging 3196596
US duplex Doppler lower extremity
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
US duplex Doppler pelvis
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
CTV abdomen and pelvis with IV contrast
10-30 mSv
☢☢☢☢
Usually appropriate
MRV abdomen and pelvis without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
US duplex Doppler IVC and iliac veins
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
Catheter venography pelvis
0.1-1mSv
☢☢
May be appropriate
US intravascular iliac veins
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
(Disagreement)
US intravascular renal veins
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
Scenario Scenario ID Procedure Adult RRL Peds RRL Appropriateness Category
Varicose veins, lower extremity, pelvic origin suspected, treatment 3196598
Conservative management


Usually appropriate
Compression sclerotherapy


May be appropriate
Microphlebectomy


May be appropriate
Saphenous vein ablation


May be appropriate
(Disagreement)
Iliac vein embolization


May be appropriate
Iliac vein stenting


Usually not appropriate
Left renal vein stenting


Usually not appropriate
Left renal vein surgery


Usually not appropriate
Ovarian vein embolization


Usually not appropriate
Iliac vein surgery


Usually not appropriate
Scenario Scenario ID Procedure Adult RRL Peds RRL Appropriateness Category
Iliocaval disease suspected, severe post thrombotic changes, initial imaging 3196600
US duplex Doppler lower extremity
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
CTV abdomen and pelvis with IV contrast
10-30 mSv
☢☢☢☢
Usually appropriate
MRV abdomen and pelvis without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
US duplex Doppler IVC and iliac veins
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
Catheter venography iliac veins
10-30 mSv
☢☢☢☢
May be appropriate
Catheter venography lower extremity
0.1-1mSv
☢☢
May be appropriate
CTV lower extremity with IV contrast
10-30 mSv
☢☢☢☢
May be appropriate
(Disagreement)
MRV lower extremity without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
(Disagreement)
US intravascular iliac veins
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
(Disagreement)
Lower extremity venous disease suspected, severe post thrombotic changes, initial imaging 3196601
US duplex Doppler lower extremity
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
CTV abdomen and pelvis with IV contrast
10-30 mSv
☢☢☢☢
Usually appropriate
MRV abdomen and pelvis without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
US duplex Doppler IVC and iliac veins
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
Catheter venography iliac veins
10-30 mSv
☢☢☢☢
May be appropriate
Catheter venography lower extremity
0.1-1mSv
☢☢
May be appropriate
CTV lower extremity with IV contrast
10-30 mSv
☢☢☢☢
May be appropriate
(Disagreement)
MRV lower extremity without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
(Disagreement)
US intravascular iliac veins
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
(Disagreement)
Scenario Scenario ID Procedure Adult RRL Peds RRL Appropriateness Category
Lower extremity disease, severe post thrombotic changes, treatment 3196604
Anticoagulation


Usually appropriate
Compression therapy


Usually appropriate
Endovascular stenting


Usually appropriate
Catheter-directed thrombolysis with or without thrombectomy lower extremity


May be appropriate
Venous angioplasty


May be appropriate
Saphenous vein ablation


May be appropriate
(Disagreement)
Venous bypass procedure


May be appropriate
Compression sclerotherapy


Usually not appropriate
Iliocaval disease, severe post thrombotic changes, treatment 3196603
Anticoagulation


Usually appropriate
Compression therapy


Usually appropriate
Endovascular stenting


Usually appropriate
Catheter-directed thrombolysis with or without thrombectomy lower extremity


May be appropriate
Venous angioplasty


May be appropriate
Saphenous vein ablation


May be appropriate
(Disagreement)
Venous bypass procedure


May be appropriate
Compression sclerotherapy


Usually not appropriate
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