Tests

There are several reasons why tests are performed on the veins. They include checking for deep vein thrombosis (DVT), venous reflux, and/or measuring the veins for bypass or for use in a dialysis access. All venous duplex testing is digitally stored in our PACS (Picture Archiving Communications System), interpreted by a vascular laboratory physician, and forwarded to your ordering physician.

Venous duplex studies are a non-invasive way for your physician to check for the presence of a deep vein thrombosis (blood clot). Deep vein thrombosis (DVT) is a potentially fatal condition if left untreated, although treatment is often as simple as receiving blood thinners through a pill or injection. Symptoms of DVT can include swelling, pain, redness of a limb, or shortness of breath. Some have no symptoms at all.

The venous duplex is a simple test. The technologist will put warm gel over the veins to be scanned, visualize the veins using ultrasound, and push gently on the area to ensure that the veins are free of DVT. The lower extremity duplex involves the veins from the groin to the ankle, while the upper extremity duplex involves the veins from your neck, across your shoulder, and down to your wrist.

Reflux, or insufficiency, is a condition in which the valves in the veins no longer function properly. The result can be varicose veins, discoloration, swelling, or even an ulcer.

This test examines only specific veins. The technologist will apply warm gel to the legs and monitor the blood flow in the veins using ultrasound. The technologist gives a little squeeze to the leg, releases, and documents direction of blood flow.

Venous duplex mapping is performed to document location and size of certain veins. These veins are measured to ensure that they are an acceptable size to be used in a bypass, or for dialysis access. Location of the vein is documented so that your surgeon can easily find the veins to be utilized.

This test examines only the veins specifically ordered by your surgeon. Ultrasound and warm gel are used to visualize the veins. The technologist measures the vein in increments down the arm or leg. Often the technologist will draw the vein on the skin surface using a marker for the surgeon’s easy reference.

Peripheral vascular disease (PVD), sometimes called poor circulation, is the narrowing or blockage of the arteries in the arms or legs. Symptoms of PVD include coldness, tingling, numbness, cramping, and sometimes discoloration of the extremities, toes, or fingers.

There are two types of noninvasive testing performed for PVD. The first is to check for the presence of disease. This is called the segmental Doppler. This same method of testing is used to monitor arterial disease from year to year. The second method is the arterial duplex. This method is typically used to follow the corrective action taken for PVD, such as a bypass. Arterial duplex is also used to monitor a dialysis access.

The segmental doppler and pulse volume recordings are performed with blood pressure cuffs. For the lower extremities, cuffs are placed down the legs, on the foot, and even on the big toe. For upper extremity testing, cuffs are placed on the arms and fingers. The cuffs are inflated twice at each location, while the technologist collects tracings and documents pressures.

The results are digitally stored in our PACS (Picture Archiving Communications System) and examined by a vascular laboratory physician. The tracings and the vascular laboratory physician’s interpretation are sent to your referring physician.

Arterial duplex is typically performed to monitor a bypass graft or a dialysis access (graft). This test is performed using ultrasound and warm gel. The technologist looks for narrowing or blockage of the graft, while documenting the speed of blood flowing within the graft.

The test is digitally stored in our PACS (Picture Archiving Communications System) and interpreted by a vascular laboratory physician. The vascular physician's interpretation is sent to your ordering physician.

Carotid duplex is performed to check for the presence of disease of the carotid artery. The carotid arteries are on either side of your neck, and are the main source of blood flow to the brain. Symptoms of carotid artery disease include dizziness, headaches, weakness or numbness to one side of the body, and loss of vision in one eye.

Testing for carotid artery disease is performed using warm gel and ultrasound to visualize the arteries in the neck. Ultrasound enables the technologist to look for narrowing in the artery while measuring the effect of any blockage by documenting the speed of blood flow within the artery.

Transcranial Doppler (TCD) utilizes ultrasound technology to measure and record the blood flow velocity in the major intracranial arteries of the brain. It has been successful in detecting severe stenosis or blockages in major intracranial arteries and assessing flow patterns and the extent of circulation disturbances. TCD is a non-invasive test which can be repeated often and safely, thereby allowing detection of changes over time. The patient usually lies down in a comfortable position while a small hand-held probe with transmission gel is placed over the temporal area, eye, and back of head. Sound waves are projected toward key intracranial arteries and received, forming a waveform image that is measured for appropriateness of direction and blood flow velocity. These waveforms are digitally stored in our PACS (Picture Archiving Communications System) for analysis by a specially trained physician who compares them to normal criteria. A report is then sent to your physician.

Arterial duplex can also be used to examine the arteries in the abdomen. These arteries include the renal artery and the aorta. These studies are digitally stored in our PACS (Picture Archiving Communications System) and interpreted by a vascular laboratory physician.

Renal artery disease is the narrowing or blockage of the renal artery, the blood vessel to the kidney. The typical symptom of renal artery disease is uncontrollable hypertension (high blood pressure).

Renal artery duplex is performed using warm gel and ultrasound. The technologist measures the velocity (speed) of blood within the renal artery. The technologist also documents the size of both kidneys. Kidneys will atrophy (shrink) if there is a significant decrease in blood flow.

An aorta ultrasound is performed to look for the presence of an aneurysm. An aneurysm is a ballooning of the aorta (the main artery of the abdomen). This ballooning effects the walls of the aorta, weakening them. Symptoms of an abdominal aortic aneurysm (AAA) can include back pain and the ability to feel a strong pulse when placing your hand on your abdomen. Most have no symptoms at all.

The aorta ultrasound is performed using warm gel and ultrasound on your abdomen. The aorta is visualized and measured, ensuring that the largest diameter of the vessel is documented.

The Radiology Department at Capital Health also performs testing of the arteries and veins of the body. The tests performed include arteriograms, CT Scans and Magnetic Resonance Angiography (MRA).

An angiogram uses X-rays to view your body’s blood vessels. When the arteries are studied, the test is also called an arteriogram (if the veins are studied, it is called a venogram). Physicians often use this test to study narrow, blocked, enlarged, or malformed arteries in many parts of your body, including your brain, heart, abdomen, and legs.

To create the X-ray images, your physician will inject a dye through a thin, flexible tube, called a catheter. He or she threads the catheter into the desired artery from an access point. The access point is usually in your groin but it can also be in your arm. This dye, called contrast, makes blood vessels visible on an X-ray.

Sometimes physicians can also treat a problem during an angiogram. For instance, your physician may dissolve a clot that he or she discovers during the test. A physician may also perform an angioplasty and stenting procedure to clear blocked arteries during an angiogram, depending on the location and extent of the blockage. An angiogram can also help your physician plan operations to repair the arteries for more extensive problems.

CT (computed tomography), sometimes called a "cat" scan, uses special X-ray equipment to obtain image data from different angles around the body, and then uses computer processing of the information to show a cross-section of body tissues and organs.

CT imaging is particularly useful because it can show several types of tissue-lung, bone, soft tissue and blood vessels-with great clarity. Using specialized equipment and expertise to create and interpret CT scans of the body, radiologists can more easily diagnose problems such as cancers, cardiovascular disease, infectious disease, trauma and musculoskeletal disorders.

The Spiral CT at Capital Health provides extended coverage of the body, produces images with much greater detail, and allows for fast and accurate assessment of injuries. Whereas most scanners offer one-slice images, this new generation scanner shows 16, providing more data to radiologists with less wait.

Magnetic Resonance Angiography (MRA) uses magnetic fields and radio waves to produce two-dimensional or three-dimensional images of the structures inside your body, such as blood vessels. MRA is a MRI of the arteries.

The MRA equipment consists of a table that slides in and out of a donut-shaped machine. A computer attached to the machine processes radio waves and magnetic fields to create two-dimensional or three-dimensional images.

MRA not only helps your physician diagnose your condition, it also helps him or her plan treatment. MRA also may, in some circumstances, have advantages that other tests do not. For instance, MRA does not require X-ray exposure to detect narrowing of arteries, unlike computed tomography (CT) scans or arteriogram.