Vascular Disease

Vascular Test and Common Indications/Sx.

Cerebrovascular evaluation (CVE)

CVA, TIA, Visual disturbance, carotid bruit, f/u known stenosis, vertebral insufficiency, speech abnormalities, unilateral numbness or paresis, dizziness, gait abnormality, HA/migraines

Transcranial Evaluation (TCD)           

ICH, SAH, CVD, CVA, TIA, cerebral vasospasm, vertebral insufficiency               

Embolic Detection Monitoring (EMB)                                               

CVA, TIA, cardiac arrhythmia, hypercoagulability, heart valve repair/replacement      

RT-to-LT Atrial/Pulmonary Shunt Evaluation (PFO)

Cryptogenic stroke, known PFO/ASD, known PDA    

Head-Turn Syncope Testing   (HTS)                                                                      

Syncope

Dynamic Posterior Circulation Testing (DPCT)

Any vertebrobasilar insufficiency Sx w/ head movements (dizziness, unstable gait, visual defects, etc.), Hx. of cervical trauma, Hx. of cervical chiropractic adjustments

Vasomotor Reactivity Testing (VMR)

Known intracranial stenosis, known significant ICA stenosis or occlusion

Aorta/Iliac Evaluation (AAA)

Known AAA, pulsitile abdominal mass, PVD, any male over 65 that has smoked over 100 cigarettes in their lifetime, any female over 70 w/ a family history of AAA

Renal Artery Evaluation (REN)

Hypertension, elevated BUN/Creatinine, ABNL GFR, renal failure

Mesentric Evaluation (MES)

Postprandial abdominal pain

Lower Extremity Arterial Evaluation (LEA)

Extremity claudication, extremity rest pain, extremity weakness, Hx of PVD, cold extremity

Lower Extremity Venous Evaluation (LEV)

Extremity swelling, pain, edema, varicosities, Hx of DVT/SVT, Hx of hypercoagulability

Thoracic Outlet Evaluation (TOS)

Upper extremity numbness, tingling or swelling with extremity in certain position (usually upward)

Vascular Ultrasound: 

ICAVL certified lab.

Carotid Ultrasound: 

Detailed analysis of extra-cranial cerebral vessels to assess risk factors for stroke

Transcranial Doppler (TCD): 

Detailed analysis of intra-cranial cerebral vessels to assess risk factors for stroke; presence of vasospasm in TIA and headache symptoms; assess collaterals in the presence of intracranial or extra-cranial stenosis.  Can assist in evaluation of temporal arteritis by finding a “halo” sign in the temporal artery.  Is an easy non-invasive method of assessing whether dizziness symptoms are a result of posterior circulation insufficiency.  Can be used to assess whether vision changes are a result of ocular vascular disease.

Embolic testing: 

Helps determine if antiplatelet and anticoagulation therapy is adequate to in reducing cardiogenic or cerebrovascular clots that could cause TIAs and strokes.   Can localize the source of clots in TIA and stroke syndromes.

Head Turn Syncopal Evaluation: 

Helps determine of positional symptoms could be due to compression of vertebral arteries within the vertebral canal:  A not uncommon cause of posterior circulation TIAs, vertigo, and dizziness.

TCD-PFO (patent foramen ovale): 

The most sensitive method of detecting right to left shunting that can increase the risk of stroke and migraines.  Far more sensitive than TTE, and even more sensitive than TEE.

Renal Artery Ultrasound: 

Assess if hypertension or elevated creatinine is due to stenosis of renal arteries.

Abdominal Aortic Aneurysm Evaluation: 

Detailed assessment of aorta to determine existence of aneurysm and risk of rupture.  Completely covered as part of initial medicare assessment.

Lower Extremity Arterial Study: 

Detailed assessment of arteries in the entire leg from the abdomen to the feet.  Helps determine if leg pain or cramping is due to blocked blood vessels, large or small, type of plaque involved, and can guide the decision if and how intervention could help.

Lower Extremity Venography: 

Detailed leg vein assessment for deep or superficial venous thrombosis; presence and severity of varicosities, and etiology of lower extremity swelling.

Mesenteric Artery Evaluation: 

Helps determine if prandial or post-prandial pain is due to visceral ischemia.