Peripheral Vascular Laboratory
The Peripheral Vascular Laboratory at Sentara Martha Jefferson offers physicians an alternative to traditional methods of assessing vascular disorders. The studies done in the lab serve as an extension of the physical exam—further assisting in diagnosis and treatment. The lab at Sentara Martha Jefferson is specially designed utilizing the most advanced, non-invasive technology performed by personnel who are highly skilled in the identification and diagnosis of problems of the vascular system. Our technologists have achieved the highly regarded status of registered vascular technologist (RVT) and are certified by national accrediting bodies.
The laboratory specializes in comprehensive, noninvasive testing of the cerebrovascular, peripheral arterial, venous and abdominal visceral systems, including:
Noninvasive Cerebrovascular testing benefits patients with an asymptomatic carotid bruit as well as those who are at high risk for stroke or have experienced a transient or fixed neurological deficit. A noninvasive examination may also be used to follow the progression of previously identified carotid disease. Postoperatively, endarterectomy patients benefit from regular evaluation to monitor for recurrence of disease and progression of contralateral disease.
This procedure combines high resolution B-mode real-time imaging with Doppler ultrasound and spectral analysis. The scan provides anatomic and hemodynamic information regarding the cervical carotid arteries. Data regarding percent stenosis and characterization of atheromatous plaque are provided. The newest advancement, Color-flow Doppler, is used to optimize conventional data acquisition.
Peripheral Arterial Evaluation
An arterial evaluation can document the presence of disease, determine its functional severity, localize the site of involvement, define the lesion as a stenosis or occlusion, measure its length and provide baseline information for future comparisons. When musculoskeletal system disease is also present, the evaluation will determine the contribution of arterial insufficiency to the patient’s symptoms.
Segmental Pressures and Velocity Waveforms
Blood pressures at various limb levels are measured to identify areas of regional hypotension. Selected arterial velocity signals are analyzed audibly and by spectral analysis to localize the level of disease to the inflow, outflow or runoff vessels. Also, an ankle-brachial index (ABI) is determined by comparing the ratio of blood pressure in the arms to that in the legs.
Exercise testing provides a medium for evaluating the functional significance of arterial occlusive disease in the claudicant. Upon completion of a maximum walk of five minutes, arterial signals and blood pressures are reassessed at the ankle level. A patient with arterial occlusive disease will respond to exercise with a decrease in the ankle blood pressure The magnitude of the decrease and time to return to baseline establish the severity and functional significance of arterial obstruction. Stress testing is useful in differentiating the pain of arterial insufficiency from that of other conditions such as arthritis and neuropathies. It also will identify those patients whose symptoms of fatigue are due to coronary or pulmonary disease rather than arterial insufficiency.
Color-Flow Doppler Duplex Scanning
Color-flow scanning adds Doppler information encoded as color-flow to the conventional duplex scan to survey the arteries throughout their course. This test is reserved for those patients being evaluated for an invasive interventional procedure (angioplasty or surgery). It can identify all lesions as stenosis or occlusions, estimate the percentage of diameter reduction and determine the length of the lesion. In cases where angiography is contraindicated, color-flow scanning has been used at the Sentara Martha Jefferson Vascular Center in lieu of angiography for planning the surgical approach. Postoperatively, this test also is used to monitor bypass grafts for detection of conditions heralding impending graft failure so that appropriate intervention is taken prior to thrombosis.
This technique is used to obtain hemodynamic information from fingers and toes. Waveform contours obtained under ambient conditions and during reactive hyperemia identify digital artery obstructions as fixed or functional. This test is used in the evaluation of patients with cold sensitivity diseases.
Peripheral Venous Evaluation
Noninvasive testing allows diagnosis and evaluation of deep and superficial venous thrombosis and valvular insufficiency in patients with symptomatic venous disease. These procedures are rapid, repeatable and cost-effective.
Duplex Venous Evaluation
Doppler ultrasound and B-mode real-time imaging are combined to maximize the anatomic and physiologic information regarding the deep veins in the upper and lower extremities, including the major axial deep veins in the lower leg and the intramuscular veins. Ultrasound characteristics may imply an acute versus chronic process. This exam has replaced venography as the standard for detection of deep venous thrombosis. More than 150 exams are performed monthly.
Air Plethysmography (APG TM)
This procedure is a comprehensive method of evaluating lower extremity venous function. It quantitates both the efficiency of the calf muscle pump function and the magnitude of venous valve reflux while assessing the overall performance of the venous system. This test is used to evaluate those patients with chronic venous insufficiency.
Vein Mapping for Bypass Grafts and Dialysis Access
Abdominal Visceral Evaluation
Renal Artery Duplex
This procedure combines high resolution B-mode real-time imaging with Doppler ultrasound and spectral analysis. The scan provides anatomic and hemodynamic information in patients with severe hypertension regarding their renal arteries. Data regarding percent stenosis and hemodaynamic ratios are provided and this assists in planning further treatment.
Aortic Duplex for Aneurysm
Ultrasound interrogation is the most-inexpensive and accurate technique to diagnose and quantitate the presence and size of abdominal aortic aneurysms.
Mesenteric Arterial Duplex
Color-flow scanning adds Doppler information encoded as color-flow to the conventional duplex scan to carefully survey the mesenteric arteries throughout their course as they emanate from the aorta. This study is reserved for patients who demonstrate signs and symptoms of possible arterial blockage to the intestines. This test can be highly accurate in making this diagnosis.
The Sentara Martha Jefferson Peripheral Vascular Laboratory is IAC accredited in all disciplines and performs a full range of vascular examinations of the cerebrovascular, peripheral arterial, venous and abdominal visceral systems. In addition, the laboratory is actively involved in teaching throughout the hospital and community in areas involving diagnostic vascular ultrasound.
Non-invasive tests allow patients to be examined using Doppler-ultrasound (Duplex) free of the risks and discomforts of injections or invasive maneuvers. Patient examinations provide physicians with quantitative information regarding the location and functional significance of many vascular conditions and can provide diagnoses of almost all known or suspected vascular disorders.