Changes: The Latest Revisions To The ICAVL Standards [continued]

Visceral Vascular Testing

The section on techniques for examination performance was extensively expanded to better address the specifics of visceral vascular testing:

3.1.1 Visceral vascular testing comprises several distinct tests because different indications require different vascular beds to be evaluated.

3.1.1.1 Each visceral vascular system requires several vessels to be examined. Some tests also require gray scale imaging of the appropriate organ.

3.1.1.1.1 Visceral vascular tests comprise the following vessel groups:

A.) Mesenteric arterial system
B.) Hepatoportal system
C.) Renal vasculature
D.) Renal transplants
E.) Liver transplants

In addition, direction specific to application submission is now provided by the following two statements:

3.1.1.4 Laboratories can seek accreditation in one or more visceral vascular testing areas.

3.1.1.5 Laboratories must seek accreditation in all of the visceral vascular tests they perform.

The required documentation of examination standard now includes language related to examining the entire course of the accessible portions of each visceral vessel, as well as the additional images required by abnormalities. Also within this section, for renal transplants, it is now specified that gray scale images must be documented for transplant kidney and peri-transplant region. For liver transplants, intrahepatic portal vein and extrahepatic portal vein were added, and it is now specified that gray scale images must be documented for transplant liver and peri-transplant region.

The Standards now state, "The entire course of the accessible portions of each visceral vessel should be examined."

Related to representative spectral Doppler waveforms, the hepatoportal system section was expanded as follows:

B.) Hepatoportal system

• Main portal vein
• Right portal vein
• Left portal vein
• Superior mesenteric vein
• Splenic vein
• Right, left and middle hepatic vein
• Inferior vena cava
• Portosystemic shunts (when present)
• TIPS requires angle corrected waveforms with velocities from:
  • Portal vein inflow
  • Portal end of stent
  • Mid stent
  • Hepatic end of stent
  • Hepatic vein outflow

In this same section, the Standards for renal system and renal transplants were also significantly expanded:

C.) Renal system

• Adjacent aorta
• Proximal main renal artery
• Mid main renal artery
• Distal main renal artery
• Parenchymal/hilar arteries (when appropriate)
• Accessory renal artery when present
• Renal veins (when appropriate)
  Comment: A complete renal vasculature examination includes bilateral evaluation.

D.) Renal transplants

• Donor artery
• Arterial anastomosis
• Proximal transplant renal artery
• Distal transplant renal artery
• Parenchymal vessels
• Transplant renal vein
• Renal vein anastomosis

In Conclusion

The ICAVL looks forward to feedback from accredited facilities, application reviewers and site visitors about this new edition of the ICAVL Standards. The organization strives to publish standards that facilitate continuous improvement of the quality of care provided in noninvasive vascular laboratories.