RESUMO
The appropriate use criteria (AUC) has become an integral part of the cardiologist's daily practice and have evolved greatly since their inception over a decade ago. However, as health care costs continue to rise, the AUC has come to play an even more pivotal role in the way medicine-specifically cardiology-is practiced today. This editorial describes two opposing viewpoints commonly held by practicing clinicians of the AUC. Written from the perspective of two fellows-in-training looking ahead at the challenges and opportunities of clinical practice (under the auspices of several experienced clinicians and leaders of the American College of Cardiology), this article provides a fresh perspective on the impact AUC has on our patients, clinicians, and the health care system.
Assuntos
Cardiologia/normas , Tomada de Decisão Clínica , Fidelidade a Diretrizes/normas , Segurança do Paciente/normas , Guias de Prática Clínica como Assunto/normas , Padrões de Prática Médica/normas , Cardiologia/economia , Redução de Custos , Análise Custo-Benefício , Fidelidade a Diretrizes/economia , Custos de Cuidados de Saúde , Humanos , Segurança do Paciente/economia , Padrões de Prática Médica/economia , Medição de Risco , Procedimentos Desnecessários/normasRESUMO
Peripheral arterial disease (PAD) is a clinical manifestation of systemic atherosclerosis and is associated with significant morbidity and mortality. Vascular physicians come across PAD of different complexity and among them complex total occlusions present a formidable challenge to endovascular operators. Newer tools and techniques, particularly in the retrograde approach, have made endovascular therapy applicable to increasingly complex disease. In this article, we review various interventional devices and techniques that are key to achieving success in complex anatomic subsets.