Peripheral Vascular Disease

PERIPHERAL VASCULAR DISEASE

Peripheral Vascular Diseases (PVD) are circulation disorders that affect blood vessels outside the heart and brain. PVD that develops only in the arteries is called Peripheral Arterial Disease (PAD).  PAD develops most commonly as a result of atherosclerosis, or hardening of the arteries, which occurs when cholesterol and scar tissue build up, forming a substance called plaque inside the arteries. This is a very serious condition. The clogged arteries cause decreased blood flow to the arms, or more commonly, the legs.  This can result in pain when walking and eventually gangrene and/or amputation.

The most common symptom of PAD is called intermittent claudication, which is painful cramping in the leg or hip that occurs when walking or exercising and typically disappears when the person stops the activity.  Other symptoms include: numbness, tingling and weakness in the lower legs and feet, burning or aching pain in feet or toes when resting, sore on leg or foot that won’t heal, cold legs or feet, color changes in skin of legs or feet, hair loss on legs, pain in the legs or feet that wakes you up at night.

PVD that develops in the deep veins in the body is usually caused from claudication and it called Deep Vein Thrombosis (DVT).

In order to diagnose PVD, the physician will begin by taking a complete medical history and physical exam.  Several tests may be used to diagnose PVD.  They are:

  • Measuring the pulses in your legs and feet
  • Doppler ultrasound

  • Ankle-Brachial Index (ABI)
  • Pulse Volume Recording (PVR)
  • Angiography
  • Magnetic Resonance Angiography (MRA) or Computerized Tomography Angiography (CTA)

Non-Invasive (Ultrasound) Imaging Studies:

Ultrasound is a procedure that uses sound waves to "see" inside your body.  At the Vascular Institute of Virginia we have an expert team of physicians, nurses and technologists who are highly trained in ultrasound imaging.

Venous Duplex Ultrasound Scan

The purpose of a venous duplex ultrasound scan is to evaluate venous blood flow in the patient's arms and/or legs. Patients may experience symptoms such as pain, swelling or varicose veins in the arms or legs.  These scans can aid in the diagnosis of venous abnormalities such as a suspected blood clot in a deep vein of the leg (DVT); narrowing or closure (occlusion) of a vein; or impaired blood flow (venous insufficiency).

venous_duplex

Venous Doppler

A Venous Doppler ultrasound study may be part of a venous duplex ultrasound examination.  Doppler ultrasound is a special ultrasound technique that allows the physician to see and evaluate blood flow through arteries and veins in the abdomen, arms, legs, neck, or within various body organs such as the liver or kidneys.

Arterial Duplex Ultrasound Scan

An Arterial Duplex Ultrasound uses sound waves to create a color map of the arteries in your leg(s) to identify narrowing of your vessels that may be causing leg pain when walking or at rest, ulcers of the foot, ankle, heel or toe(s),  or skin discoloration. 

arterial_duplex

Peripheral Angiograms

Abdominal aortograms with runoff are arteriograms of the lower abdominal aorta and arteries in the legs. This exam is often done when the patient has pain in the calf muscle after walking a short distance, discoloration of the toes or feet, non-healing wounds or ulcers, or a "cold" foot.

Once angiographic images have been obtained and problem areas identified, some of the methods we employ to treat those diseased areas are Angioplasty, Thrombectomy, Atherectomy, or Stent placement.

Angioplasty uses a balloon catheter to open up a stenotic area, or area of narrowing, in a blood vessel.

angioplasty

Thrombectomy is the process in which thrombus (or clot) is mechanically removed from the body using specialized equipment.

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Atherectomy refers to the mechanical removal of atheroma or atherosclerosis from the inside of the vessels in the body, using specialized catheters and equipment.

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Stents are small metal scaffolds that can be placed in order to maximize the inner diameter of vessels and help to keep it open.

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Renal Duplex Ultrasound Scan

The renal arteries provide blood flow to the kidneys. Renal artery disease, including narrowing (stenosis) due to atherosclerosis, can result in reduced blood-flow to the kidney. This can cause hypertension (high blood pressure). Renal artery stenosis is the most common correctable cause of hypertension. Long-standing, untreated renal artery disease is also a common cause of kidney failure.

Renal artery disease cannot be diagnosed without specific tests. Renal artery duplex scanning is accurate, non-invasive and cost-effective. Unlike angiography or CT scanning, no injection of X-ray contrast material is required, avoiding the risk of kidney damage from the contrast.

Blood-flow velocities and flow patterns in the aorta and renal arteries are evaluated with Doppler ultrasound. Imaging of the kidneys can provide information about secondary damage to the kidneys from chronic poor blood-flow.

Carotid Duplex Ultrasound Scan

A carotid duplex scan is a test that combines two types of ultrasound to look for blockages in your carotid arteries. Your carotid arteries are located along both sides of your neck. Blocked carotid arteries are a major risk factor for stroke.

Other names for a carotid duplex scan are:

  • Carotid Artery Duplex 
  • Carotid Ultrasound
  • Vascular Ultrasound
  • Carotid Artery Doppler