VASCULAR STUDIES
Vascular testing is an important method to determine the cause of vein problems as well as artery problems. Non-invasive ultrasound testing is the cornerstone of modern vascular diagnosis.
Vascular Testing Index
Clinical indications
Arterial
- claudication
- rest pain
- gangrene
- Reynaud’s
- ischemic leg or foot ulcerations
- diabetic foot evaluation
- peripheral aneurysms
- extremity bypass graft surveillance
- assessment of hemodialysis access graft
- assessment of extremity circulation before and after hemodialysis graft placement
Venous
- leg swelling/pain
- deep vein thrombosis
- superficial thrombophlebitis
- varicose veins
- post phlebitic syndrome
- venous ulcerations
- venous stasis changes
- vein mapping for coronary or peripheral arterial reconstruction
Carotid
- transient ischemic attack (TIA)
- cerebrovascular accidents
- amarousis fugax
- carotid bruit
- carotid stenosis
- follow-up after carotid endarterectomy
- vertebral basilar insufficiency
- subclavian steal syndrome
Abdominal
- abdominal aortic aneurysm
- aorto-iliac occlusive disease
- renovascular hypertension
- renal insufficiency
- post prandial pain in the face of weight loss
- iliac or caval thrombosis
- renal, mesenteric or iliac stenosis surveillance
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Peripheral arterial studies
Doppler ultrasound analysis and segmental blood pressure evaluation provides physiological data to quantify the severity of disease. Duplex ultrasound allows for accurate assessment of arterial flow, flow-reducing plaque and dilated (aneurismal) segments.
Duplex testing is also used to evaluate the effectiveness of peripheral bypass and hemodialysis access grafts, which allows for identification of graft stenosis prior to occlusion and, in selected cases, may lead to prophylactic intervention.
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Peripheral venous studies
Duplex ultrasonography is an effective way to evaluate the deep and superficial venous system for thrombosis.
Deep vein thrombosis (DVT) can be diagnosed with a very high rate of accuracy, and serial examinations allow for assessment of thrombus propagation. Testing results are especially useful when patients should not receive anticoagulation therapy unless absolutely necessary (in the case of calf vein thrombosis, for example).
Air plethysmography (APG) can be used for the evaluation of chronic venous insufficiency with a high degree of accuracy, and also quantifies the amount of reflux. Valvular incompetence may lead to varicose veins, hyperpigmentation of the skin and, ultimately, venous ulceration. APG can identify the etiology of this condition, allowing the clinician to direct treatment appropriately.
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Carotid artery studies
Duplex ultrasound technology provides a noninvasive, highly accurate and safe method to evaluate the extracranial carotid arteries for plaque morphology and degree of stenosis. The accuracy rate is high enough that, in selected cases, angiography may be avoided.
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Abdominal vascular studies
Ultrasonography can be used to assess several vascular structures in the abdomen. The aorta and iliac arteries can be evaluated for the presence of aneurysms, and followed serially to evaluate diameter change in a cost-effective manner. Stenosis of the renal arteries, causing renovascular hypertension or renal insufficiency, can be detected. Stenosis of the mesenteric arteries, causing post prandial pain and weight loss, can be detected. Evaluation of the inferior vena cava, iliac, hepatic and portal veins can be performed to assess flow and level of obstruction.
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Vascular Tests
Arterial
Carotid Imaging with Doppler
Depicts left and right common carotid artery systems from base of neck to above bifurcation. Shows plaque and stenosis, measures blood flow velocities and extent of disease.
Transcranial doppler when requested
Physiological Upper and Lower Extremity Arteries
Segmental blood pressure measurements, continuous Doppler waveform analysis, plethysmography.
ABI's
Duplex Imaging - Upper and Lower Extremities
Images lumen of arteries in extremities using 2D and color flow mapping. Doppler gives spectral characteristics of blood flow and velocity which will determine degree of stenosis.
Venous
Duplex Imaging Upper and Lower Extremities
Images veins in upper and lower extremities. Doppler gives characteristics of blood flow.
Visceral vascular
Duplex Organs
Images arterial inflow and venous outflow of abdominal, pelvic and/or retroperitoneal organs.
Duplex Aorta, Inferior Vena Cava, Iliac Vasculature
Images of these vessels and/or tributaries as well as flow patterns. Doppler gives characteristics of blood flow.
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Duplex Scanning in DVT and VI
Noninvasive evaluation of deep venous thrombosis (DVT) has become an important technique because of the unreliability of the physical exam, the invasive nature of venography, and the potential danger of resultant pulmonary emboli. Doppler ultrasound and plethysmography (PVR,IPG, PRG) are the most commonly used noninvasive procedures, but are limited by their inability to accurately detect non-occlusive major thrombi and calf thrombil. Furthermore, these tests do not determine the nature and location of the thrombus. Duplex scanning has gained wide acceptance in carotid evaluation. Talbot first introduced the concept of clinically utilizing Real time B-Mode imaging in the extremity veins in a preliminary report in 1982. Since that time, several investigators have reported on the success of Duplex scanning in the noninvasive diagnosis of deep venous thrombosis.In order to master the technique of Duplex scanning in DVT evaluation, one must know the anatomy in transverse and sagittal planes.
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Venous Doppler
It is important to remember that plethysmographic and non-imaging Doppler modalities do not detect directly the presence of DVT in an extremity, but they can detect significant obstruction to venous outflow. The direct, noninvasive detection of deep venous thrombosis can be made only with an imaging technique. Although duplex ultrasound imaging is now the method of choice for the detection of DVT, venous Doppler is an important component of the duplex technique.
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Vascular Testing FAQs
Q: What is vascular testing?
A: Vascular testing checks whether the circulation in your legs are working properly. Circulation consists of arteries, which bring blood from your heart down to your feet; and veins, which bring blood from your feet up to your heart.
Q: When is it important to test arteries?
A: Arteries stop working well when they get clogged (just like arteries in the heart or brain can get clogged). Any patient with a wound on the legs or feet needs to be tested for blocked arteries in the legs, or "peripheral arterial disease." If your arteries are not working properly to carry blood to your legs, this can prevent a wound from healing. If your arteries are blocked, you may need to see a vascular surgeon in order to open your arteries and allow your wound to heal.
The ankle-brachial index (ABIs) is the main test used to measure for PAD. The blood pressure in your leg is compared to the blood pressure in your arm. This ratio is called an ABI. Doppler imaging is a non-invasive method that measures the blood flow in the arteries with sound waves to get a picture of blood flow and any blockage in the arteries. CT or MRI can also be used to get a better picture of your arteries.
Q: When is it important to test veins?
A: Blood flows up the veins because of valves within the veins that carry the blood upwards. Normally, blood flows from the veins near the surface of your legs, into the deep veins, and up to the heart. In some people, the valves stop working well. Blood flow then gets backed up, and flows in the wrong direction. This causes high pressure in the veins near the surface of your legs, and that interferes with wound healing.
Patients with poor circulation in the veins typically get wounds on the legs or the top of the foot. If you have a wound in this region, we will send you to have your veins tested. By examining your veins, we can confirm if this is a reason why your wound doesn't heal. If your veins are not working properly, a vascular surgeon can seal off one of the veins near the surface, in order to improve the overall flow in the veins. This does not help the wound to heal. However, it will help prevent new wounds from forming.
In venous flow studies, ultrasound is used to check the blood flow in the veins.
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