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PVD Venous AUC Rating Sheet 2nd Round 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Median I NI MADM Rating Agree Disagree Upper Extremity Venous Evaluation Table 1. Venous Duplex of the Upper Extremities for Patency and Limb Swelling 1 Unilateral acute 9 9 9 9 9 9 9 9 8 9 8 9 9 9 9 9 9 9 0.1 A + 2 Unilateral chronic, persistent 7 7 7 6 7 6 7 9 7 7 8 7 8 7 8 7 7 7 0.5 A + Bilateral acute 3 Suspected central venous obstruction 9 9 7 8 7 6 9 8 8 9 5 9 9 7 6 8 8 8 1.1 A + Bilateral chronic, persistent No alternative diagnosis identified (e.g., no CHF or anasarca from hypoalbuminemia) 9 8 7 7 7 6 8 7 7 8 5 7 9 7 6 7 7 7 0.7 A + 4 Suspected central venous obstruction Limb Pain (Without Swelling) Non-articular pain in the upper extremity (no indwelling upper 5 extremity venous catheter) 5 6 6 8 8 6 4 7 5 6 2 5 4 4 2 5 6 4 1.4 U Non-articular pain in the upper extremity with indwelling upper 6 extremity venous catheter 5 7 8 8 7 7 5 6 8 7 7 5 8 7 5 7 7 7 0.9 A 7 Tender, palpable cord in the upper extremity 8 9 9 8 7 7 9 9 8 7 8 9 9 8 9 8 8.5 8 0.7 A + Suspected pulmonary embolus (no indwelling upper extremity 8 venous catheter) 5 4 5 4 3 3 7 5 3 7 2 9 3 4 2 4 4.5 3 1.5 U Suspected pulmonary embolus with indwelling upper extremity 9 venous catheter 5 5 7 7 5 6 4 6 6 7 2 8 6 7 4 6 5.5 6 1.1 U Diagnosed pulmonary embolus (no indwelling upper extremity 10 venous catheter) 5 6 3 4 2 5 1 3 4 7 2 9 2 4 2 4 3.5 4 1.7 U Diagnosed pulmonary embolus with indwelling upper extremity 11 venous catheter 5 6 5 6 4 7 6 3 6 7 7 9 8 6 4 6 5.5 7 1.1 U Fever 12 Fever of unknown origin (no indwelling upper extremity venous 5 2 3 4 5 1 1 2 1 6 1 4 1 4 2 2 2.5 2 1.5 I 13 Fever with indwelling upper extremity venous catheter 5 5 7 7 3 4 9 3 1 7 1 4 1 6 3 4 5 3 2.0 U Known Upper Extremity Venous Thrombosis 14 New upper extremity pain or swelling while on anticoagulation 7 8 7 7 4 7 7 7 3 7 8 7 9 9 8 7 7 8 0.9 A + New upper extremity pain or swelling, not on anticoagulation (i.e., 15 contraindication to anticoagulation) 7 8 7 7 4 7 8 7 5 7 8 8 9 9 8 7 7 8 0.9 A + 16 Before anticipated discontinuation of anticoagulation treatment 7 6 5 3 5 4 7 5 6 7 8 5 5 3 5 5 5 5 1.1 U 17 Shortness of breath in a patient with known upper extremity DVT 3 7 3 3 3 3 1 3 3 7 3 9 3 3 2 3 3 3 1.1 I + 18 Not on anticoagulation, phlebitis location < 5 cms from deep Surveillance after diagnosis of upper extremity superficial phlebitis 3 3 7 7 5 4 4 6 8 7 3 6 9 6 2 6 4.5 6 1.7 U Surveillance after diagnosis of upper extremity superficial phlebitis 19 Not on anticoagulation, phlebitis location > 5 cms from deep vein 3 5 5 6 2 1 3 3 8 6 3 5 7 4 2 4 3 5 1.7 U Vein Mapping Prior to Bypass Surgery (Coronary or Peripheral) 20 In the absence of adequate leg vein for harvest 9 8 7 8 8 8 8 8 8 7 7 5 9 9 7 8 8 7 0.7 A + 21 In the presence of adequate leg vein for harvest 3 5 3 5 4 5 4 5 3 3 2 7 3 4 3 4 4.5 3 1.0 U Screening Examination for Upper Extremity DVT 22 Prior to pacemaker or implantable cardiac defibrillator placement 3 5 3 6 2 3 4 4 7 4 1 2 3 4 2 3 3.5 3 1.2 I Prolonged ICU stay (e.g., > 4 days) 23 No indwelling upper extremity venous catheter 1 4 3 5 2 1 1 3 2 3 1 2 3 1 2 2 2.5 2 0.9 I +

Prolonged ICU stay (e.g., > 4 days) 24 Indwelling upper extremity venous catheter 3 4 3 5 3 3 3 4 3 4 1 2 6 2 2 3 3 2 0.9 I 25 Monitoring indwelling upper extremity venous catheter that is 1 3 3 2 2 1 1 3 3 3 1 2 2 2 1 2 2 2 0.7 I + 26 In those with high-risk: acquired, inherited or hypercoagulable 1 4 2 6 2 1 1 3 3 3 1 6 2 2 2 2 2 2 1.1 I + 27 Positive D-dimer test in a hospital inpatient 1 1 2 5 1 1 1 1 3 3 1 5 3 1 2 1 1 3 1.1 I + Lower Extremity Venous Evaluation Table 2. Venous Duplex of the Lower Extremities for Patency and Limb Swelling 28 Unilateral acute 9 9 9 9 9 9 9 9 8 9 9 8 9 9 9 9 9 9 0.1 A + 29 Unilateral chronic, persistent 7 6 7 6 8 6 7 8 7 7 8 6 9 7 7 7 7 7 0.6 A + 30 Bilateral acute 9 6 7 8 7 7 9 8 8 9 5 7 9 8 7 8 7.5 8 0.9 A + No alternative diagnosis identified (e.g., no CHF or anasarca from 31 hypoalbuminemia) 7 7 5 6 5 4 6 7 7 7 5 7 7 6 5 6 6 7 0.9 U Limb Pain (Without Swelling) 32 Non-articular pain in the lower extremity (e.g. calf or thigh) 5 7 7 8 5 7 6 7 7 7 5 6 7 6 6 7 7 6 0.7 A 33 Knee pain 3 1 5 2 2 5 7 5 5 4 1 5 5 1 1 4 4 4 1.7 U 34 Tender, palpable cord in the lower extremity 9 8 8 8 4 7 9 8 8 7 8 8 9 8 9 8 8 8 0.7 A + 35 Suspected pulmonary embolus 9 3 7 7 9 7 9 7 7 8 7 9 9 9 9 8 7 9 1.2 A + 36 Diagnosed pulmonary embolus 9 6 5 7 7 5 5 5 8 8 6 9 9 8 5 7 5.5 8 1.4 A Fever 37 Fever of unknown origin (no indwelling lower extremity venous 3 1 5 7 6 5 1 2 1 5 1 5 2 7 5 5 4 5 1.9 U 38 Fever with indwelling lower extremity venous catheter 3 5 5 7 3 7 6 6 1 7 5 5 5 8 5 5 5.5 5 1.3 U Known Lower Extremity Venous Thrombosis Surveillance of calf vein thrombosis for proximal propagation in 39 patient with contraindication to anticoagulation (within 2 weeks of 5 7 8 7 7 7 7 9 8 8 7 7 9 7 7 7 7 7 0.6 A + 40 New lower extremity pain or swelling, while on anticoagulation 7 9 7 7 7 7 7 7 7 7 8 7 8 9 8 7 7 8 0.5 A + New lower extremity pain or swelling, not on anticoagulation (i.e., 41 contraindication to anticoagulation) 7 9 9 7 7 7 7 8 7 7 8 8 9 8 8 8 7 8 0.7 A + 42 Before anticipated discontinuation of anticoagulation treatment 3 6 7 2 5 4 4 3 7 6 7 5 6 3 5 5 4 6 1.3 U 43 Shortness of breath in a patient with known DVT 3 6 5 7 3 6 3 3 5 7 1 8 5 4 5 5 4 5 1.5 U Surveillance after diagnosis of lower extremity superficial phlebitis 44 Not on anticoagulation, phlebitis location < 5 cms from deep vein 3 7 7 8 7 7 7 6 7 8 5 6 9 6 5 7 7 6 1.0 A Surveillance after diagnosis of lower extremity superficial phlebitis 45 Not on anticoagulation, phlebitis location. 5 cms from deep vein 3 4 5 6 6 6 5 5 7 7 5 5 7 5 5 5 5 5 0.8 U + Vein Mapping Prior to Bypass Surgery (Coronary or Peripheral) 46 In the absence of prior lower extremity vein harvest or ablation 9 8 8 8 8 8 7 7 8 8 8 5 9 9 7 8 8 8 0.6 A + 47 In the presence of prior lower extremity vein harvest or ablation 9 8 7 6 9 9 7 8 8 8 8 6 9 8 8 8 8 8 0.7 A + Screening Examination for lower extremity DVT 48 After orthopedic surgery 3 3 4 7 2 6 3 3 1 5 2 6 7 2 3 3 3 3 1.5 I 49 Prolonged ICU stay (e.g., > 4 days) 3 5 3 7 2 6 3 3 1 5 1 5 6 2 2 3 3 2 1.5 I 50 In those with high-risk: acquired, inherited or hypercoagulable 3 3 3 7 3 3 1 4 1 5 1 7 7 2 2 3 3 2 1.5 I 51 Positive D-dimer test in a hospital inpatient 5 1 3 2 1 5 1 3 1 3 1 6 2 1 5 2 2.5 2 1.5 I + Post Endovenous (Great or Small) Saphenous Ablation 52 Lower extremity swelling or pain 7 9 8 7 9 8 9 8 8 8 7 7 9 7 8 8 8 8 0.6 A + Routine post procedure follow-up, no lower extremity pain or 53 swelling Within 10 days post procedure 3 6 7 7 6 7 5 7 8 7 2 6 9 7 5 7 6.5 7 1.3 A Other Symptoms of Vascular Disease

54 Physiologic testing positive for venous obstruction 9 7 5 4 7 7 7 9 7 7 8 6 9 7 7 7 7 7 0.9 A + Patent foramen ovale with suspected paradoxical embolism for 55 patient without lower extremity pain or swelling obstruction 3 5 7 7 8 7 9 7 7 7 8 6 9 7 7 7 7 7 0.9 A + Table 3. Duplex Evaluation for Venous Incompetency Venous Insufficiency (Venous Duplex with Provocative Maneuvers for Incompetency) 56 Active venous ulcer 9 9 9 9 9 6 9 7 9 8 8 6 9 7 7 9 9 8 0.9 A + 57 Healed venous ulcer 3 7 7 7 9 7 7 7 9 6 7 5 9 6 5 7 7 6 1.1 A 58 Spider veins (telangiectasias) 3 3 3 3 2 2 3 6 6 2 2 5 5 4 2 3 3 4 1.1 I 59 Varicose veins, entirely asymptomatic 3 5 5 6 2 3 1 5 5 3 1 5 9 7 3 5 4 5 1.7 U 60 Varicose veins with lower extremity pain or heaviness 7 7 7 7 9 5 8 7 7 7 7 6 9 7 5 7 7 7 0.7 A + Visible varicose veins with chronic lower extremity swelling or skin 61 changes of chronic venous insufficiency (e.g., hyperpigmentation, 7 7 7 8 9 7 9 9 9 8 7 7 9 7 7 7 7.5 7 0.8 A + Skin changes of chronic venous insufficiency without visible 62 varicose veins (e.g., hyperpigmentation, lipodermatosclerosis) 7 7 5 8 9 7 7 9 9 8 4 6 8 6 4 7 7 6 1.3 A 63 Lower extremity pain or heaviness without signs of venous disease 3 6 5 6 7 5 6 6 5 4 8 6 5 5 5 5 6 5 0.9 U + 64 Mapping prior to venous ablation procedure 5 7 8 8 8 8 8 8 9 8 8 8 9 7 7 8 8 8 0.5 A + Prior endovenous (great or small) saphenous ablation procedure 65 with new or worsening varicose veins in the ipsilateral limb 7 7 8 8 9 8 6 8 9 8 8 7 9 8 7 8 8 8 0.6 A + Prior endovenous (great or small) saphenous ablation procedure 66 with no residual symptoms. 1 5 5 3 3 2 3 7 3 2 2 4 5 4 5 3 3 4 1.3 I Table 4. Venous Physiological Testing (Plethysmography) With Provocative Maneuvers to Assess for Patency and/or Incompetency Limb Pain, Swelling or Other Signs of Venous Disease 67 Active venous ulcer 9 7 7 8 7 6 4 7 9 6 7 5 7 8 6 7 7 7 0.9 A 68 Varicose veins, entirely asymptomatic 1 5 5 7 2 3 3 5 9 5 2 4 5 7 2 5 4 5 1.7 U 69 Varicose veins with lower extremity pain or heaviness 7 5 7 7 4 7 4 7 9 7 8 6 5 8 5 7 7 7 1.1 A Varicose veins with chronic lower extremity swelling or skin 70 changes of chronic venous insufficiency (e.g., hyperpigmentation or 7 5 7 7 4 8 4 8 9 7 7 7 7 7 2 7 7 7 1.1 A + Skin changes of chronic venous insufficiency without visible 71 varicose veins (e.g., hyperpigmentation or lipodermatosclerosis) 7 5 7 7 8 8 4 8 9 8 3 7 4 7 2 7 7 7 1.5 A 72 Lower extremity pain or heaviness without signs of venous disease 7 4 3 7 8 5 2 7 9 6 2 6 1 7 2 6 6 6 2.1 U - Limb swelling: unilateral acute 73 Suspected acute venous thrombosis 9 3 3 7 2 1 2 7 9 5 2 7 2 3 4 3 3 4 2.2 I - 74 Suspected pulmonary embolus 9 1 3 6 2 1 1 6 1 3 1 8 1 3 2 2 2.5 2 2.0 I + Duplex Evaluation of the Inferior Vena Cava (IVC) and Iliac Veins Table 5. Duplex of the IVC and Iliac Veins for Patency and Thrombosis) Prior to IVC filter placement 75 Prior to IVC filter placement 9 7 7 7 6 4 3 8 3 7 3 7 3 6 5 6 7 5 1.7 U Evaluation for suspected deep vein thrombosis Lower extremity swelling - unilateral or bilateral as a stand 76 alone test without a venous duplex of the lower extremities 3 1 3 2 3 1 1 3 3 3 1 7 1 3 1 3 2.5 3 1.1 I + Lower extremity swelling unilateral or bilateral combined 77 routinely with a venous duplex of the lower extremities 9 1 5 2 5 2 1 5 1 3 1 7 5 4 5 4 3.5 4 2.0 U

Lower extremity swelling unilateral or bilateral performed 78 selectively when the lower extremity venous duplex is normal 9 6 5 7 7 2 4 7 1 7 2 6 1 7 5 6 6.5 5 2.0 U Lower extremity swelling unilateral or bilateral performed 79 selectively when the lower extremity venous duplex is positive for 9 9 7 8 7 7 7 7 9 5 7 8 9 7 6 7 7 7 0.9 A + Selectively - When the flow pattern in one or both common 80 femoral veins is abnormal 9 9 9 8 8 8 8 8 7 7 7 7 7 8 7 8 8 7 0.6 A + Evaluation for suspected pulmonary embolus Pulmonary symptoms (suspected pulmonary embolus) - as a stand 81 alone test without a venous duplex of the lower extremities 3 1 3 2 2 1 1 2 1 3 1 8 2 3 1 2 2 2 1.1 I + Pulmonary symptoms (suspected pulmonary embolus) combined 82 routinely with a venous duplex of the lower extremities 9 1 5 2 4 5 3 6 1 3 1 8 8 4 4 4 4.5 4 2.0 U Evaluation of Other Symptoms or Signs of Abdominal Vascular Disease 83 Abdominal pain 3 3 3 4 4 2 1 3 1 3 1 5 4 2 3 3 3 3 0.9 I + 84 Abdominal bruit 3 3 3 3 4 2 1 3 1 1 1 5 4 2 3 3 3 2 0.9 I + 85 Fever of unknown origin 3 1 3 5 1 1 1 3 1 3 1 5 3 4 3 3 2 3 1.1 I + Table 6. Duplex of the Hepatoportal System (portal vein, hepatic veins, splenic vein, superior mesenteric vein, inferior vena cava) for Patency, Thrombosis, and Flow Direction Evaluation of Hepatic Dysfunction or Portal Hypertension Abnormal liver function tests No alternative diagnosis identified (e.g. medication related or 7 5 9 7 6 4 6 7 5 6 6 6 4 7 5 6 6.5 6 0.9 U 86 infectious hepatitis) 87 Cirhhosis with or without ascites 7 6 8 8 2 7 7 7 1 6 7 5 5 7 7 7 7 6 1.3 A Jaundice 88 As an initial diagnostic test 7 4 5 2 2 2 3 6 1 6 2 2 3 4 1 3 3.5 2 1.5 I Jaundice 89 No alternative diagnosis identified (e.g. biliary obstruction) 7 5 5 7 4 6 5 7 1 5 6 6 2 7 7 6 5.5 6 1.3 U 90 Hepatomegaly and/or splenomegaly 7 7 7 7 7 7 6 7 1 5 3 6 7 7 7 7 7 6 0.9 A 91 Portal hypertension 7 7 9 7 9 8 9 7 5 5 7 6 9 8 8 7 7.5 7 1.1 A + Surveillance following Portal Decompression Procedure 92 Follow-up of a TIPS 7 7 9 9 9 8 9 7 9 7 7 6 9 8 7 8 8.5 7 0.9 A + Evaluation of Symptoms or Signs of Abdominal Vascular Disease 93 Abdominal pain 3 3 7 7 4 2 6 7 1 3 1 4 4 5 4 4 5 4 1.5 U 94 Fever of unknown origin 3 3 5 5 2 2 1 5 1 3 1 5 3 4 2 3 3 3 1.2 I Evaluation of Cardiac and/or Pulmonary Symptoms 95 Pulmonary symptoms (suspected pulmonary embolus) 5 1 3 6 1 2 1 3 1 3 1 8 3 2 3 3 2.5 3 1.5 I + 96 Cor pulmonale 5 1 5 5 2 2 1 3 5 3 1 7 3 3 4 3 2.5 3 1.4 I Table 7. Duplex of the Renal Veins for Patency and Thrombosis* Evaluation for Suspected Renal Vein Thrombosis Potential Signs and/or Symptoms 97 Gross hematuria 9 2 7 3 5 2 1 5 5 4 1 6 2 2 3 3 4 3 1.9 I 98 Acute renal failure 9 5 3 7 7 3 4 5 1 6 1 6 8 2 4 5 5 4 2.0 U 99 Acute flank pain 9 4 3 6 7 5 3 5 5 5 1 6 3 2 3 5 5 3 1.6 U Evaluation of Cardiac and/or Pulmonary Symptoms 100 Pulmonary symptoms (suspected pulmonary embolus) 3 2 3 5 1 2 1 3 1 3 1 8 7 2 3 3 2.5 3 1.5 I + Evaluation of Other Symptoms or Signs of Abdominal Vascular Disease 101 Drug-resistant hypertension (suspected renal artery stenosis) 3 2 3 2 2 2 5 3 1 3 1 5 2 3 3 3 2.5 3 0.9 I + 102 Microscopic hematuria (prior to urological evaluation) 3 4 5 3 2 2 1 3 1 3 1 4 2 2 2 2 3 2 0.9 I +

103 Fever of unknown origin 3 4 5 7 1 2 1 4 1 3 1 4 1 2 2 2 3.5 2 1.4 I 104 Epigastric bruit 3 4 2 3 3 2 1 3 1 3 1 3 2 2 2 2 3 2 0.7 I + Hemodialysis Vascular Access Duplex Ultrasound Table 8. Preoperative Planning and Postoperative Assessment of a Vascular Access Site* Assessment Prior to Access Site Placement Preoperative Mapping Study (Upper extremity arterial and 105 venous duplex) 3 months prior to access placement 5 5 3 5 3 1 3 4 1 3 1 7 1 6 5 3 3.5 3 1.6 I Preoperative Mapping Study (Upper extremity arterial and 106 venous duplex) <3 months prior to access placement 9 8 8 8 9 9 9 7 9 7 8 7 9 8 8 8 8.5 8 0.6 A + Failure to Mature Failure to Mature on basis of physical examination 0-6 weeks 107 after placement 5 6 8 4 9 9 7 6 7 5 1 6 5 4 8 6 6.5 5 1.6 U Failure to Mature on basis of physical examination >6 weeks 108 after placement 9 8 9 7 5 9 9 8 7 8 8 6 8 8 7 8 8.5 8 0.8 A + Symptoms and Signs of Disease* Signs of access site malfunction during dialysis (e.g., low blood 109 flows, kt/v, recirculation times or increased venous pressure) 9 8 9 7 5 8 7 8 9 8 8 7 9 7 7 8 8 8 0.8 A + 110 Mass associated with an AVF/AVG 9 6 9 9 5 8 9 8 9 8 8 7 1 8 7 8 8.5 8 1.3 A + 111 Loss of palpable thrill of AVF/AVG 9 7 9 9 8 8 2 8 9 7 8 7 8 8 8 8 8 8 0.9 A + 112 Arm swelling 9 7 8 8 8 5 9 8 9 7 8 7 8 8 8 8 8 8 0.6 A + Hand pain, pallor, and/or digital ulceration (i.e., evaluation for 113 suspected arterial steal syndrome) 9 8 9 8 4 1 9 8 9 8 8 7 8 8 9 8 8 8 1.1 A + Cool extremity 114 Without pain, pallor, or ulceration 9 5 3 6 2 1 3 4 7 2 2 6 3 3 3 3 3.5 3 1.6 I 115 Difficult cannulation by multiple personnel on multiple attempts 9 8 8 6 6 8 9 6 8 7 8 7 8 8 7 8 8 8 0.7 A + Asymptomatic 116 Routine surveillance of a functioning AVF or AVG 3 3 5 5 5 1 1 3 1 3 1 6 7 3 3 3 3 3 1.4 I +

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