Most Americans are familiar with heart disease and with the consequences of blockages in the vessels that carry blood to and from the heart. But few people realize that blockages caused by a buildup of plaque and cholesterol affect more than coronary arteries. Arteries throughout the body carry oxygenrich blood away from the heart, so blockages can occur in all arteries with serious effects. Three of the most recognized vascular diseases include:
An angiogram detects blockages using X-rays taken during the injection of a contrast agent (iodine dye).
An angiogram is an X-ray procedure that can be both diagnostic and therapeutic. It is considered the gold standard for evaluating blockages in the arterial system. An angiogram detects blockages using X-rays taken during the injection of a contrast agent (iodine dye). The procedure provides information that helps your vascular surgeon determine your best treatment options.
Angiograms are typically performed while you are sedated. The procedure may last 15-20 minutes or up to several hours, depending on how difficult the test is and how much treatment is given.
Angioplasty can be used to open arterial blockages. Guided by X-ray, your vascular surgeon navigates through the blockage with a wire and introduces a special device equipped with an inflatable balloon. After positioning the balloon device across the blocked portion of the artery, the vascular surgeon inflates the balloon to expand the artery and compress the blockage. The balloon is then deflated and removed while keeping the wire in place across the area that has been treated. Next, contrast dye is injected to assess the result. Treatment is considered a success if blood flow is improved and less than 30% of the blockage remains. If the vessel is still considerably narrowed, placing a stent may be the next step.
Stents are used to prop open an artery at the site of a narrowing. Stents are generally placed after balloon angioplasty when there is residual narrowing or insufficient blood flow in a treated vessel. Stents are considered a permanent implant and cannot be used if you have a metal allergy. Stents that are used in the leg are constructed of a nickel-titanium alloy (Nitinol), a memory-shaped metal. This alloy has a predetermined size and shape at body temperature and expands to this size and shape after being introduced through a catheter. These stents resist kinking and are flexible so that damage from activities that involve your legs is minimized.
If surgery is felt to be a better option, your vascular surgeon will obtain any additional X-ray images needed to plan a surgical bypass of the blocked vessel/s and will then conclude the angiogram.
All invasive procedures can have complications. While the risk of an angiogram is low it is not zero. The most common complications are related to the arterial access site.
Bruising is common
You will likely have bruising (ecchymosis) where the artery was entered.
Pain and bleeding
Less commonly, patients experience pain and bleeding that may include blood collecting under the skin (hematoma).
Blockage or leakage
In rare cases, the access artery can become blocked. Infrequently, patients experience persistent leakage of blood where the artery was entered, which can result in the formation of a pseudoaneurysm—a blood-filled sac—that may require further treatment.
Other complications related to an angiogram include:
A non-invasive test that uses inflatable cuffs to gauge circulation (blood flow) and measure blood pressure in the arteries at various locations on the thigh, calf, foot and toes.
Also called: Segmental Pressure Test, Toe Pressure Test, Toe-Brachial Index (TBI)
Blood pressure cuffs of various sizes are placed on your thigh, calf, foot and toes. Similar to having your blood pressure checked with an arm cuff, as the technician inflates the cuffs, they progressively tighten and are then quickly released. You may feel some discomfort, but generally for less than 60 seconds for each measurement.
Aside from the momentary discomfort described above, side effects or complications are very rare.
This painless, noninvasive test is used to see and measure the rate at which blood flows through your carotid arteries and look for possible blockages. No radiation, dye or needles are used.
Also called: carotid Doppler, carotid ultrasound, Doppler ultrasound.
This painless, noninvasive test is used to see and measure the rate at which blood flows through your carotid arteries and look for possible blockages. No radiation, dye or needles are used. The test is performed in our office with our Registered Vascular Technician. The results are read by the Vascular Surgeon.
You may be given a carotid duplex test to determine whether plaque has accumulated in your arteries, causing carotid artery disease (hardening of the arteries). This is a no-risk test.
The technician will send the ultrasound images to your vascular surgeon for evaluation. Typically, a report is available in 2–3 days. If anything critical is found, the Ultrasound Technician will let the vascular surgeon know immediately.
Duplex ultrasound is a non-invasive evaluation of blood flow through your arteries and veins.
Also called: Doppler Test, Vascular Lab Test, Duplex Exam, Duplex Scan, Ultrasound, Ultrasound Exam.
Duplex ultrasound is a non-invasive evaluation of blood flow through your arteries and veins . This test provides information to help your vascular surgeon make a sound diagnosis and outline a treatment plan. Accuracy is critical, so ultrasound testing should ALWAYS be performed by a credentialed sonographer in an accredited vascular laboratory.
Many arteries and the veins can be studied by ultrasound, including the carotid, arm and leg arteries as well as the abdominal aorta. Veins are also tested to help detect a clot or reflux.
Ultrasound examinations are painless and easy for the patient. The vascular laboratory will contain a bed and just two or three pieces of equipment. The examination can be done in comfortable clothing; disposable shorts or gowns may be provided. It usually takes about 30 minutes.
There are typically no side effects or complications associated with duplex ultrasound examinations.
There is little preparation required for duplex ultrasound. Occasionally, patients may need to fast before an abdominal exam.
There should be no side effects following a vascular laboratory exam. The results of your study can often be immediately available to your doctor.
CCTA and MRA tests are non-invasive, advanced imaging studies that provide detailed information about the blood vessels within our bodies and their anatomic relationships with other organs.
CTA and MRA tests are non-invasive, advanced imaging studies that provide detailed information about the blood vessels within our bodies and their anatomic relationships with other organs. These tests use ;modern computerized image processing techniques that let your vascular surgeon view vascular disease three-dimensionally—an important step in assessing the extent of the disease and how best to treat it.
Which is right for you?
Your vascular surgeon decides which imaging study to perform based on a number of factors, including:
While CTA is a safe test when performed judiciously, the amount of radiation involved is not insignificant if repeated examinations are planned.
To get an idea of how much radiation is involved, the radiation from a typical CTA is equivalent to about 50 plain-film chest X-rays—about the amount of radiation the average person receives passively each year from the environment (“background radiation”).
An MRA is considered preferable for repeated examinations, but the availability and expertise of interpreting MRA images varies as outlined above.