ACR Appropriateness Criteria® Sudden Onset of Cold, Painful Leg

Clifford R. Weiss*, Ezana M. Azene, Bill S. Majdalany, Ali F. AbuRahma, Jeremy D. Collins, Christopher J. Francois, Marie D. Gerhard-Herman, Heather L. Gornik, John M. Moriarty, Patrick T. Norton, Thomas Ptak, Stephen P. Reis, Frank J. Rybicki, Sanjeeva P. Kalva, Expert Panel on Vascular Imaging:

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

13 Scopus citations


Acute limb ischemia (ALI) requires urgent diagnosis and treatment to prevent limb loss. Invasive digital subtraction arteriography (DSA) is the gold standard for diagnosing ALI. DSA is the only diagnostic modality that permits simultaneous treatment of acute arterial occlusion. Noninvasive imaging with MRA or CT angiography may also be appropriate before treatment, especially when the diagnosis of ALI is in doubt or where DSA is unavailable. Other imaging and noninvasive physiologic tests may prove important for longer term management but are less recommended in the acute setting. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

Original languageEnglish (US)
Pages (from-to)S307-S313
JournalJournal of the American College of Radiology
Issue number5
StatePublished - May 2017


  • ALI
  • AUC
  • Appropriate Use Criteria
  • Appropriateness Criteria
  • acute limb ischemia
  • angiography
  • arteriography
  • cold leg

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging


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