As part of the Choosing Wisely Canada campaign the Canadian Society for Vascular Surgery releases

Group aims to encourage physicians and patient conversations by identifying five tests or procedures to question, highlighting potentially unnecessary-sometimes harmful- care in vascular surgery.

OTTAWA, June 2, 2015 The Canadian Society for Vascular Surgery (CSVS) today released a list of specific tests, treatments or procedures that are commonly ordered but not always necessary in Vascular Surgery as part of Choosing Wisely Canada. The list identifies five (5) targeted, evidence-based recommendations that can support conversations between patients and physicians about what care is really necessary.

The Canadian Society for Vascular Surgery's list identified the following five (5) recommendations:

Don't perform percutaneous interventions or bypass surgery as first line therapy in patients with asymptomatic peripheral arterial disease (PAD) and in most patients with claudication.
PAD is a marker of a systemic disease and patients with PAD may have atherosclerotic disease in other vascular beds, including the carotid and coronary circulation. Patients with mild to moderate PAD have a higher 5 year risk of stroke, myocardial infarction or cardiovascular death than amputation. Initial therapy should include smoking cessation and risk factor modification, medical therapy and a walking program. Lower extremity bypass surgery and endovascular therapy should be reserved for patients with limb threatening ischemia or truly disabling claudication.

Don't perform carotid endarterectomies or stenting in most asymptomatic high risk patients with limited life expectancy.
The purpose of carotid artery surgery and stenting is to prevent stroke and, when combined with appropriate medical therapy, is a successful strategy in selected, mainly symptomatic, patients. Medical therapy alone is an effective alternative in many asymptomatic patients and safer in those who are elderly or at high risk for surgery and stenting and don't have the life expectancy to benefit from such a prophylactic procedure.

Don't perform open or endovascular repair in most asymptomatic patients with small abdominal aortic aneurysms (<5cm in women, <5.5cm in men).
Repair of asymptomatic abdominal aortic aneurysms is recommended when the risk of rupture exceeds the risk of repair. Randomized controlled trials have failed to show a survival benefit for open or endovascular repair of most small aneurysms. Repair may be considered with specific growth patterns and aneurysm morphology.

Don't perform endovascular repair of abdominal aortic aneurysms in most asymptomatic high risk patients with limited life expectancy.
Repair of asymptomatic abdominal aortic aneurysms is recommended when the risk of rupture exceeds the risk of repair and is performed in patients with sufficient life expectancy to allow them to benefit from such a prophylactic procedure. Most elderly, or medically high risk patients, have insufficient life expectancy and are at higher risk of complications following endovascular repair to warrant intervention.

Don't perform unnecessarily frequent ultrasound examinations in asymptomatic patients with small abdominal aortic aneurysms. Aneurysms smaller than 4.5cm in diameter should undergo ultrasound surveillance every 12 months.
Regular ultrasound examination of asymptomatic patients with small abdominal aortic aneurysms is essential to document aneurysm growth and decide when intervention is warranted. The interval between examinations is dictated by the size of the aneurysm and its expected growth rate. Too frequent examinations can cause undue patient anxiety and are not cost effective.

The Canadian Society for Vascular Surgery's Choosing Wisely Canada list was developed after months of careful consideration and review, using the most current evidence about management and treatment options. "The Canadian Society for Vascular Surgery is very proud to participate in this important Choosing Wisely Canada initiative", says CSVS President, Dr. Thomas Forbes. "As responsible physicians we must continuously question the need and appropriateness of tests and interventions and this list will help our members and their patients have a conversation regarding these issues."

"Conversations about what care patients truly need is a shared responsibility among all members of the health care team", said Wendy Levinson, MD, Chair of Choosing Wisely Canada. The Canadian Society for Vascular Surgery's Choosing Wisely list will help vascular surgeons across the country engage their patients in a dialogue about what care is best for them, and what we can do to reduce waste and overuse in our health care system".

To date nearly 100 national and provincial medical specialty societies, regional health collaboratives and patient and community partners have joined the conversations about appropriate care. With the release of these new lists, the campaign will have covered more than 150 tests and procedures that the specialty society partners say are overused and inappropriate, and that physicians and patients should discuss.

To learn more about Choosing Wisely Canada and to view the complete lists and additional detail about the recommendations and evidence supporting them, visit www.ChoosingWiselyCanada.org

The Canadian Society for Vascular Surgery is a national organization leading vascular care in Canada and is dedicated to excellence in the promotion of vascular health for Canadians through education, research, collaboration and advocacy.

Choosing Wisely Canada is a campaign to help physicians and patients engage in health conversations about potentially unnecessary tests, treatments and procedures, and to help physicians and patients make smart effective choices to ensure high-quality care. It got underway initially in Ontario and has been endorsed by all provincial and territorial medical associations who have established mechanisms to support the adoption of the Choosing Wisely Canada recommendations. It is now a truly national campaign.

For further information: Christiane Dowsing, Phone: 613-286-7583, E-mail: info@canadianvascular.ca

As part of the Choosing Wisely Canada campaign the Canadian Society for Vascular Surgery releases list of commonly used tests and treatments to question

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