 Estimates of the prevalence of claudication in the general population range from 1.6% to almost 8%, depending on age, sex, the geographic location of the population, and the diagnostic criteria used [2,3]. In most studies, fewer than 10% of patients with intermittent claudication progress to chronic limb-threatening ischemia in 5 years [4,5]. However, one large meta-analysis of 16,440 patients demonstrated that 21% of patients with intermittent claudication progressed to chronic limb-threatening ischemia [6]. The presence of vascular disease in patients with symptoms of claudication is reliably established by a variety of noninvasive hemodynamic tests. In the absence of demonstrable arterial disease, imaging studies of other systems, such as the lumbar spine or soft tissues of the pelvis, may be indicated. If peripheral vascular disease is confirmed, additional studies may be indicated to screen the heart and carotid arteries for involvement [2]. Initial Imaging Definition Initial imaging is defined as imaging at the beginning of the care episode for the medical condition defined by the variant. More than one procedure can be considered usually appropriate in the initial imaging evaluation when: The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through representation of such organizations on expert panels. Participation on the expert panel does not necessarily imply endorsement of the final document by individual contributors or their respective organization. Reprint requests to: publications@acr.org OR Special Imaging Considerations CT angiography (CTA) in the tibial arteries is limited by the difficulty in accurately timing the image acquisition with respect to arrival of the iodine bolus: images acquired too late will have problematic venous contamination; images acquired too early will not have adequate contrast enhancement.
Lower Extremity Arterial Claudication Imaging Assessment for Revascularization.  Estimates of the prevalence of claudication in the general population range from 1.6% to almost 8%, depending on age, sex, the geographic location of the population, and the diagnostic criteria used [2,3]. In most studies, fewer than 10% of patients with intermittent claudication progress to chronic limb-threatening ischemia in 5 years [4,5]. However, one large meta-analysis of 16,440 patients demonstrated that 21% of patients with intermittent claudication progressed to chronic limb-threatening ischemia [6]. The presence of vascular disease in patients with symptoms of claudication is reliably established by a variety of noninvasive hemodynamic tests. In the absence of demonstrable arterial disease, imaging studies of other systems, such as the lumbar spine or soft tissues of the pelvis, may be indicated. If peripheral vascular disease is confirmed, additional studies may be indicated to screen the heart and carotid arteries for involvement [2]. Initial Imaging Definition Initial imaging is defined as imaging at the beginning of the care episode for the medical condition defined by the variant. More than one procedure can be considered usually appropriate in the initial imaging evaluation when: The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through representation of such organizations on expert panels. Participation on the expert panel does not necessarily imply endorsement of the final document by individual contributors or their respective organization. Reprint requests to: publications@acr.org OR Special Imaging Considerations CT angiography (CTA) in the tibial arteries is limited by the difficulty in accurately timing the image acquisition with respect to arrival of the iodine bolus: images acquired too late will have problematic venous contamination; images acquired too early will not have adequate contrast enhancement.