CarePoint Health is committed to the early detection and treatment of peripheral arterial disease, the build-up of atherosclerotic plaque in the arteries that supply the legs with blood. Despite the high prevalence of this disease, it is under-diagnosed and frequently goes untreated.
CarePoint Health has added state-of-the-art technology to address blockages in the arteries outside of the heart. We offer a full complement of services to restore circulation, including angioplasty, stent placement, atherectomy, and intravascular ultrasound. We also provide a wide range of vascular ultrasound studies, including carotid duplex, venous duplex, arterial Doppler and duplex, renal artery duplex, and dialysis access imaging.
Peripheral vascular ultrasound
Vascular ultrasound is a noninvasive (the skin is not pierced) procedure used to assess the blood flow in arteries and veins. A transducer (like a microphone) sends out ultrasonic sound waves at a frequency too high to be heard.
When the transducer is placed on the skin at certain locations and angles, the ultrasonic sound waves move through the skin and other body tissues to the blood vessels, where the waves echo off of the blood cells. The transducer picks up the reflected waves and sends them to an amplifier, which makes the ultrasonic sound waves audible.
There are several types of peripheral ultrasound exam including carotid duplex, venous duplex and arterial Doppler. These tests are helpful in locating blockages, abnormal valves, peripheral vascular disease and stroke symptoms. The specifics will vary depending on the type of test.
In most cases, you will lie on your back while a water-soluble gel is placed on your skin over the extremity being tested. A hand-held transducer, which transmits high-frequency sound waves, will be passed over the area being tested. Often, blood pressure cuffs will be placed around your legs or arm depending on the type of test. The ultrasound or Doppler records images during this process.
The purpose of a carotid-artery duplex scan is to detect the presence of atherosclerosis (narrowing caused by plaque) in your carotid arteries, which are the arteries in your neck that supply blood flow to your brain. A water-based gel will be applied to your neck, and an ultrasound transducer will be used to obtain the images and sound of your blood flow. This scan is painless and takes approximately 45 minutes to an hour. No special preparation is required for this examination.
The purpose of a venous duplex scan is to detect the presence of thrombus (blood clot) in your veins. A water-based gel will be applied to your legs, and images of your veins and the sound of blood flow within them will be recorded using ultrasound.
You will be asked to perform various breathing maneuvers and will feel compressions of your leg in several places throughout the test. This examination is usually painless, although you may feel some discomfort if your leg is tender. This procedure takes approximately 1 hour to perform, and no special preparation is required.
This Doppler technique is used to measure and assess the flow of blood through the arteries. The amount of blood pumped with each beat is an indication of the size of a vessel’s opening. Also, Doppler can detect abnormal blood flow within a vessel, which can indicate a blockage caused by a blood clot, a plaque, or inflammation.
A water-based gel will be applied to your legs, and an ultrasound probe, or transducer, will be used to scan the arteries in your legs. Images of your arteries and the sound of your blood flow will be recorded. This portion of the examination takes approximately one hour.
Pulse volume recordings and segmental pressures
Blood pressure cuffs are placed on your thighs, calves and ankles (both legs). The blood pressure cuffs are inflated slightly, and waveforms as well as blood pressures are obtained. Blood pressures are obtained by using a special microphone, a Doppler transducer, to listen to the pulses at your ankles.
This procedure is painless and takes approximately 30 minutes. If the blood pressures and the waveforms are normal, it may be necessary for you to walk on a treadmill to determine the effects of exercise on lower-extremity blood flow and blood pressure. If the blood pressures remain normal, no further testing is required. If the blood pressures drop, an ultrasound evaluation of the arteries will be performed.
Peripheral angiography and Intervention
Peripheral angiography is a diagnostic study, not an operation, performed to look at the arterial blood flow from the lower abdomen down each leg. During the procedure, a catheter (small, thin hollow tube) is inserted into an artery or vein and passed down the legs.
Through this catheter, radiographic contrast material, or dye, is injected into the peripheral arteries. When injected, the contrast material mixes with the blood in the arteries and allows the doctor to visualize the blood flow through the arteries. Our trained physicians perform vascular procedures using innovative equipment to treat symptoms with angioplasty and stenting.
Percutaneous Transluminal Angioplasty (PTA)
Your doctor may recommend a PTA, which is a procedure that improves blood flow through the peripheral arteries when an area of narrowing or plaque has been identified. During angioplasty, a balloon-type catheter is threaded into a vein and expanded to compress plaque and improve blood flow. You may feel pain or cramping in the affected leg but this will subside. The PTA is successful when the narrowed artery has been opened wide enough to allow adequate blood flow.
Your doctor may also choose to place a stent at the area of narrowing. A stent is a metal coil, slotted or mesh tube that is mounted on a balloon. When the balloon is inflated, the stent expands. When the balloon is deflated, the stent remains expanded, acting as scaffold to hold the artery open. A stent is placed permanently in the artery; the lining of the artery will grow over the stent.
Totally Percutaneous Endovascular Aneurysm Repair of Abdominal Aortic Aneurysm
Totally Percutaneous Endovascular Aneurysm Repair of Abdominal Aortic Aneurysm is a procedure that requires only small incisions in the groin along with the use of x-ray guidance and specially-designed instruments to repair the aneurysm. With the use of special endovascular instruments and x-ray images for guidance, a stent-graft is inserted via the femoral artery and advanced up into the aorta to the site of the aneurysm.
A stent-graft is a long cylinder-like tube made of thin metal mesh framework (stent), while the graft is made of various materials such as Dacron or polytetrafluoroethylene (PTFE). The graft material may cover the stent. The stent helps to hold the graft open and in place.
The standard invasive treatment for abdominal aortic aneurysm is open surgical repair. The aneurysm is cut open and a graft is sewn in above and below the weakened area to allow normal blood flow. Endovascular stent-graft placement is a minimally invasive alternative to open surgery.