Diagnostic Exams

Extracranial cerebrovascular exams are performed to access the cervical carotid (common, internal, and external) and vertebral arteries to determine the hemodynamic status of these vessels and to detect the presence of pathology.

Common Indications:
• Symptoms of TIA (Unilateral weakness, numbness, tingling, speech difficulties, stroke with recovery)
• Amaurosis fugax
• Carotid bruit
• Vertebrobasilar insufficiency (dizziness, imbalance, loss of consciousness)
• Follow-up of known carotid stenosis
• Post intervention follow-up (carotid endarterectomy, stent, etc.)
• Trauma in the distribution of the carotid artery

Lower extremity arterial evaluation accurately reports the extent of arterial insufficiency or occlusive disease and localizes and quantifies stenosis within the lower extremities utilizing a non-invasive approach. The presence, size and location of aneurysms and pseudoaneurysms can also be identified using this exam. Particularly helpful is the ability to non-invasively differentiate true claudication from pseudoclaudication (e.g., leg pain of non-vascular etiology).

Common Indications:

• Chronic arterial occlusive disease
• Symptoms of claudication (calf, thigh and/or hip pain with walking or exercise that resolves with short rest)
• Symptoms of rest pain
• Ulceration
• Gangrene
• Acute arterial occlusion (pain, pallor, pulselessness, parasthesias, and paralysis)
• Aneurysm
• Pseudoaneurysm
• Follow-up post PTA/stenting
• Follow-up post bypass grafting

Patients are referred for a lower extremity venous evaluation for suspected acute deep vein thrombosis (DVT) and/or superficial vein thrombosis and chronic venous insufficiency (chronic venous obstruction and/or valvular incompetence). Patients are also seen for follow-up evaluations of a known DVT to document progression or resolution of the thrombotic process.

Common Indications:

• Limb pain, swelling, or tenderness
• Limb cyanosis and/or erythema
• Symptoms of embolus (peripheral or pulmonary)
• Shortness of breath
• Chest pain
• Dyspnea
• Hemoptysis
• Respiratory distress
• Low-grade fever of unknown origin
• Varicosities induration
• Hyperpigmentation
• Ulceration

The great saphenous vein is often used for coronary or peripheral arterial bypass graft surgery.  Additionally, the cephalic or basilic veins (of the upper extremity) can be mapped for dialysis access use.  A diameter of 0.3 cm (or 3 mm) is typically the best vein caliber for these surgeries.  The saphenous, cephalic or basilic veins are imaged then marked and mapped on the skin surface.  Periodic diameter measurements as well as venous flow samples are taken and reported to the surgeon.  The surgeon notifies the technologist of the type of surgical procedure and specifies which limbs are to be mapped and/or marked.

With over 100,000 patients on chronic hemodialysis, duplex ultrasonography is often called upon to evaluate patients with dialysis access sites for potential defects and complications prior to graft failure from thrombosis.

Common Indications:
• Change in the bruit or thrill of the graft
• Prolonged dialysis times
• Elevated venous pressure found during dialysis
• Difficult needle placement for dialysis
• Abnormal lab values
• Arm swelling, and digital pain, numbness or tingling

Renal Vascular Evaluation
Hypertension affects over 20% of the adult population. Renovascular disorders are among the rare secondary causes of hypertension and include renal arterial lesions from either atheroma or fibromuscular dysplasia. Other findings in the renal vascular exam include intrinsic renal parenchymal disease, mesenteric stenosis or extrinsic compression, and aneurysm.

Common Indications:
• Hypertension (new onset or uncontrollable)
• Follow-up post PTA/stenting
• Follow-up bypass grafting
• Follow-up renal allograft

Mesenteric Vascular Evaluation
Of the three intra-abdominal branches supplying the majority of flow to the gastrointestinal organs, an acute obstruction has a very dramatic clinical presentation and requires immediate measures with elevated patient risk. A less severe chronic flow restriction allows for the development of collateral vessels, yet may result in the more intermittent symptoms seen below.

Common Indications:
• Abdominal pain associated with eating
• Fear of food
• Chronic diarrhea
• Unexplained weight loss

Hepato-Portal Evaluation
Often, patients with suspected pathology within the liver have other disease processes at work and may present with complicated symptoms. Mint Medical evaluates the vasculature that feeds and drains the liver, determines the direction of the portal vein flow (whether hepatopetal or hepatofugal), and identifies portal vein thrombosis, hepatic vein thrombosis, and patency and status of porto-systemic shunts and Transjugular Intrahepatic Portosystemic Shunts (TIPS).

Common Indications:
• Suspected portal hypertension with esophageal/bleeding varices
• Abdominal pain
• Abdominal distention
• Ascites
• Hepatic encephalopathy
• Venous hum
• Cruveilhier-Baumgarten Syndrome
• Budd-Chiari Syndrome with sudden abdominal epigastric pain with nausea and vomiting
• Hepatomegaly
• Splenomegaly
• Abdominal collateral vein distention
• Follow-up post porto-systemic shunting (including TIPS).

Arteriovenous Fistula
It occurs when an artery and vein that are side-by-side are damaged and the healing process results in the two becoming linked.  For example, after catheterizations, arteriovenous fistulas may occur as a complication of the arterial puncture in the leg or arm.

Pseudoaneurysm
It is also known as a false aneurysm & results from an injury to an artery that causes blood to leak and pool outside the injured artery’s wall.  A pseudoaneurysm is generally a consequence of an iatrogenic trauma, most likely a previous invasive medical procedure that necessitated intrusion into an artery, for example to place a stent.

Arterial Dissection
It’s a tear or seperation of the layers of the artery wall, which may be spontaneous or tramatic.

The evaluation of aortoiliac disease and its effect on blood flow dynamics, using duplex ultrasound technology.

Common Indications:
• Pulsatile abdominal mass
• Presence of an aneurysm at another anatomical location
• A history of hypertension with family history of Abdominal Aortic Aneurysm (AAA) and age >50 years
• Surveillance of known abdominal aortic or iliac artery aneurysm for increase in size
• Aortic coarctation
• Back pain
• Evidence of distal emboli
• Evidence of lower extremity inflow arterial disease
• Surveillance of arterial vascular intervention/reconstruction
• Abdominal and/or groin bruit
• Screening approved with the Medicare SAAAVE Act