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November 3, 1989

Interventional Procedures in Peripheral Atherosclerotic Disease

JAMA. 1989;262(17):2387-2388. doi:10.1001/jama.1989.03430170047023

To the Editor.—  I find two substantial problems with the review of percutaneous transluminal angioplasty and other interventional procedures for peripheral atherosclerosis by Widlus and Osterman.1 First, the indications for these procedures seem imprecise. At a time when there is increasing scrutiny by private insurers, by the Medicare PRO, and by the major vascular surgery societies of the indications for peripheral vascular surgery, it is remarkable that these interventions by radiologists could seem to be offered at a lesser standard of patient selection. For example, I do not consider failure of a walking program of 1 to 3 miles a day to be truly disabling claudication, neither is the chronicity of symptoms a reason for suggesting an angiographic study or intervention. Likewise, the fact that a patient has suffered an acute occlusive event with resultant claudication, such as thrombosis of a superficial femoral artery, is not of necessity grounds