Vascular Testing

An accurate diagnosis is vital to your treatment plan, to guide our recommendations for the most appropriate approach. Vascular testing provides critical information for an accurate diagnosis, such as:

• Presence of vascular disease
• Type of vascular disease
• Severity of the condition
• Exact location of the issues causing your symptoms

When you come to our vascular disease specialists, our doctors begin with a thorough evaluation to understand all your health needs. For in-office exams and testing, you can expect:

• Complete physical exam
• Discussion of your health history, including other conditions you may have, your family’s medical history and possible risk factors
• Review of any previous imaging studies
• Blood tests to check for signs of underlying conditions
• Consultation with one of our vascular surgeons or vascular medicine specialists
• Referral for additional imaging, as needed
• Referral to a medical geneticist if you have a known or suspected inherited (congenital) disorder, such as familial aortic disease

Your doctor works closely with our vascular lab team for imaging and other tests to help with diagnosis. We also use imaging to check your health at regular intervals, keeping you safe over the long term.

Ultrasound

These scans use sound waves to create pictures of internal structures such as soft tissues that typically don’t display well on X-rays. Ultrasound is the most commonly used imaging study to diagnose vascular disease. We do ultrasounds of arteries and veins throughout the body, including the:

• Neck: Carotid arteries
• Abdomen: Abdominal aorta, inferior vena cava, and visceral arteries and veins, which carry blood to and from organs that include the intestines, kidney, liver, pancreas and spleen
• Pelvis: Iliac arteries and veins
• Arms and legs: Peripheral arteries and veins

Our vascular lab offers several types of ultrasound:

• Doppler ultrasound measures the velocity (speed and direction) of blood flow through blood vessels.
• Duplex ultrasound combines traditional ultrasound imaging with Doppler ultrasound to assess blood flow, blood vessel size, and the presence and extent of any blockages.
• Duplex color-flow ultrasound uses color to highlight the direction of blood flow.

Non-invasive physiologic arterial testing

• Pulse volume recordings (PVR): We use blood pressure cuffs to assess blood flow in the arms and/or legs. PVR studies can help determine whether you have vascular disease.
• Ankle-brachial index (ABI) test: We compare blood pressure measurements from your arm to your ankle to calculate an ABI ratio. By following specific criteria, we can determine the presence and severity of peripheral artery disease in the legs.
• Thoracic outlet test: This test combines Doppler ultrasound and blood pressure measurements to examine your arms. We determine whether blood flow to the arms decreases with certain positions or movements.

Segmental Doppler pressures

Similar to the ABI test, this test combines blood pressure measurements and Doppler ultrasound. It helps identify areas of blockage in the legs or arms.

To start, our technologist places blood pressure cuffs at multiple spots on your arms or legs. The technologist then inflates and deflates each cuff one at a time, while using Doppler ultrasound to assess blood flow. By following specific criteria, we can determine the presence, severity and level of peripheral artery disease.

Depending on your symptoms, you may need additional imaging of blood vessels to check for damage or blockages. We coordinate your testing with our radiologists and interventional radiologists, for studies such as:

Angiography/arteriography

For this minimally invasive procedure, the vascular surgeon inserts a catheter (thin, flexible tube) through a tiny incision in an artery. After guiding the catheter to the affected area, the doctor injects a contrast agent, which helps highlight damage or blockages for X-rays.

Computed tomography (CT) angiography or venography

Specialized X-ray equipment produces 3D images of internal structures, without the need to go inside blood vessels. Before the scan, you receive an injected contrast agent such as iodine, which circulates through arteries and veins. The contrast agent helps highlight damaged or blocked arteries and veins for the CT scans.

Lymphoscintigraphy

This study provides images of the lymphatic system, a network of fluid-filled vessels that helps remove harmful substances from the body. We can usually diagnose swelling called lymphedema with a physical exam and review of your symptoms. Sometimes, though, we may need to use lymphoscintigraphy to pinpoint the blocked lymph vessels.

Lymphoscintigraphy is considered nuclear imaging, since you receive an injection of a small amount of radioactive material. The material collects at blockages, and a special camera takes images of where it ends up to help your doctor plan treatment.

Magnetic resonance angiography (MRA) or venography (MRV)

A large magnet and radio waves produce cross-sectional images of the body. The procedure is similar to CT angiography, in that you:

• Receive an injected contrast agent before the scan
• Avoid procedures that go inside your arteries or veins

Noninvasive and minimally invasive ultrasound

Our interventional radiologists use ultrasound for a more detailed view of the aorta and other blood vessels. The ultrasound procedures we offer include:

• Echocardiogram (echo): Standard heart ultrasounds, also called transthoracic echocardiograms, are noninvasive. The radiologist places a handheld instrument (transducer) on your chest and upper abdomen to take pictures of the heart and aorta.
• Intravascular ultrasound: We use a catheter procedure to look inside blood vessels. The catheter has a tiny ultrasound device at its tip that produces images from within the blood vessel. We can identify a narrowing or blockage and can also measure arteries or veins to determine the size of stents (tiny, metal-mesh tubes) to keep the blood vessel open, if needed.
• Transesophageal echocardiogram (TEE): This echo procedure takes images of the heart from inside the esophagus. To start, you receive medicine to numb the back of your throat. The radiologist then inserts a probe (thin tube that’s flexible but firm) down your throat. The probe has an ultrasound device at its tip to take the images.

Venography

Similar to angiography, venography uses a contrast agent to highlight blocked or damaged areas in veins. In this procedure, you may receive the contrast agent via an injection or a catheter-based procedure. We then take X-rays, CT scans or MR scans to produce images.

Our team of imaging specialists diagnoses vascular diseases that affect arteries, veins and lymph vessels.

Artery diseases

We offer specialized imaging for aortic disease diagnosis. Some of the arterial conditions we diagnose include:

• Aortic aneurysm
• Aortic dissection
• Carotid artery disease
• Peripheral artery disease

Vein diseases

Vein conditions we diagnose include:

• Chronic venous insufficiency
• Deep vein thrombosis
• Spider veins
• Superficial thrombophlebitis, a blood clot in a vein near the skin’s surface, which causes inflammation
• Varicose veins
• Venous ulcers, open skin sores caused by poor blood flow in leg veins

Disorders that compress veins

Venous compression syndromes develop when major veins are squeezed by nearby structures, potentially reducing blood flow or causing blood clots. Some of the syndromes we diagnose include:

• Klippel-Trenaunay-Weber syndrome, a congenital (present since birth) disorder that causes red birthmarks and abnormal development of certain veins, tissues and bones
• May-Thurner syndrome, compression of the iliac vein that returns blood from the left leg to the heart
• Nutcracker syndrome, compression of the left kidney vein
• Paget-Schroetter syndrome, a type of thoracic outlet syndrome, with compression of veins in the armpit or shoulder

Other vascular diseases

Other vascular conditions we diagnose include:

• Lymphedema
• Thoracic outlet syndrome
• Vasculitis, inflammation of arteries or veins