Pediatric Peripheral Vascular Disease (PVD) Imaging Guidelines

This policy covers imaging for pediatric peripheral vascular disease—including CT angiography (chest, extremities, abdomen/pelvis, aorto‑iliofemoral runoff), PET/CT and nuclear medicine studies, abdominal ultrasound, and vascular duplex examinations—to evaluate suspected or monitored PVD in children. It applies to patients ≤18 years with documented active signs/symptoms or guideline-supported surveillance and requires a prior pertinent clinical evaluation (detailed history/physical, appropriate labs and basic imaging or a meaningful telehealth contact); atypical presentations require physician review, asymptomatic screening is not supported, and repeat imaging is limited to cases of progression, new disease, or when it will affect management.

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