• Cerebrovascular Evaluation
• Lower/Upper Extremity Arterial Evaluation
• Lower/Upper Extremity Venous Evaluation
• Renal Evaluation
• Abdominal Aortic Aneurysm (AAA)
• Mesenteric Evaluation
• Hepato-Portal Evaluation
• Thoracic Outlet Evaluation
• Raynaud's Evaluation
• Dialysis Access Site Evaluation

For information about an exam not listed here please visit our section entitled "Exams for Clinicians"

A cerebrovascular evaluation uses noninvasive ultrasound to examine the blood flow to the brain. As blood leaves the heart via the aorta, it circulates up through the carotid and vertebral arteries on each side of the neck to the head.

During a cerebrovascular evaluation the technologist will pass a transducer (probe) over your neck and head. The test includes examination of the subclavian, vertebral, internal and external carotid arteries as well as intracranial circulation. In all, up to 24 arteries may be interrogated during this comprehensive evaluation. This noninvasive test is used to detect and quantify the degree of obstruction, which may have formed in any of the arteries listed above from a build up of cholesterol or fatty material called plaque. This build up, referred to as atherosclerosis, increases an individual's risk for stroke. Common symptoms indicating the need for a cerebrovascular evaluation may include one or more of the following:

• Numbness, weakness, or inability to move (paralysis) of face, arm or leg especially on one side of the body
• Trouble seeing in one or both eyes (such as dimness, blurring, double vision, or loss of vision)
• Confusion, trouble speaking or understanding
• Trouble walking, dizziness, loss of balance or coordination
• Severe headache with no known cause
• Stroke
• Transient Ischemic Attack

Important note - Transient Ischemic Attacks ( TIA's)

Often a stroke is preceded by a warning signal called a Transient Ischemic Attack (TIA). A TIA is the temporary interruption of the normal blood supply to the brain. The symptoms of a TIA may last a few seconds or several hours and can include numbness or weakness temporary loss of vision or balance and more. Many people ignore the signs because the symptoms go away within 24 hours. It is important to recognize the warning signs and promptly seek medical assistance.

If you have been referred for a venous evaluation, noninvasive ultrasound will be used to evaluate blood flow in your legs or arms or both. Veins return deoxygenated blood to the heart. There are two main sets of veins in the legs: deep veins which lie well within the tissue, and superficial veins which are closer to the surface. Deep Vein Thrombosis (DVT) refers to the development of a blood clot in the deep veins, which can cause partial or total blockage of blood flow in these vessels. Pain, swelling or redness in the limb may result. Unlike 'superficial thrombophlebitis' (a blood clot in the superficial veins), DVT is of more serious concern since there exists the possibility that it might break off and travel to the lungs. This is called pulmonary embolism. The risk of pulmonary embolism is reduced by prompt recognition and treatment of DVT.

During a venous evaluation the technologist will pass a transducer (probe) over your limb(s) to examine blood flow within the veins. Some of the specific veins routinely examined include the inferior vena cava, common and external iliac veins, common and superficial femoral veins, popliteal veins, common tibial and peroneal trunk veins, the greater saphenous veins. Common symptoms indicating the need for a venous evaluation may include one or more of the following:

• Pain, swelling or tenderness in the limb
• Ulcers or sores, particularly in the ankle region, that have difficulty healing
• A bluish discoloration of the skin
• An abnormal flush or redness of the skin
• Suspected pulmonary embolus

An arterial evaluation examines the arteries in the body, which carry oxygen rich blood from the heart to cells and organs. An upper or lower extremity arterial evaluation examines blood flow through the arteries in the arms or legs. Normally the inner wall of an artery is smooth allowing blood to flow freely. If atherosclerosis develops (often called "hardening of the arteries") the inner lining becomes thick which can cause an artery to narrow or even close off completely. This is called a "stenosis". When this happens blood must detour through other vessels to circulate around the blockages. This type of alternate circulation is called "collateral circulation". Atherosclerosis occurs in all vessels to some extent, although the arteries of the heart, neck and legs are most commonly affected. Peripheral Arterial Disease (PAD) refers to blockages in the peripheral arteries.

If you have been referred for a Lower or Upper Extremity Arterial evaluation ultrasound will be used to assess blood flow through the arteries, the significance and location of any atherosclerotic build up (stenosis), and the effectiveness of collateral circulation to compensate for blocked arteries. An arterial evaluation begins with blood pressure measurements in the arms and the ankles. Based on a calculation of the two measurements, the technologist may begin the ultrasound scan or may have you walk on a treadmill.

During an ultrasound scan the technologist will pass a transducer (probe) over your limbs to evaluate blood flow of the arteries.. The exam may also include evaluation of arteries in your trunk and pelvic region (abdominal aorta and iliac arteries) as they supply blood to the legs. This exam is also helpful in diagnosing abdominal aortic, iliac, femoral and popliteal aneurysms (a bulging of the wall of a blood vessel). Specific arteries in the lower trunk and in the leg that are routinely examined include the abdominal aorta, common and external iliac arteries, common and superficial femoral arteries and popliteal arteries. (Arteries in the calf, including the anterior and posterior tibial arteries, and the peroneal arteries are examined electively.) Specific arteries in the upper trunk and arms that are routinely examined include the subclavian, axillary, brachial, ulnar and radial arteries.

Common symptoms indicating the need for an arterial evaluation may include one or more of the following:

• Pain, abnormal coloring, or lack of pulses in any portion of the extremities
• Pain or cramping in the calf, thigh or buttock that is alleviated with rest
• A severe ache in the toes, forefoot or heel which is relieved by inducing blood flow with gravity (for example, dangling the foot over the bed)
• Ulcers or sores that have difficulty healing
• Gangrene

A renal vascular evaluation examines blood flow in the kidneys and renal arteries (arteries that supply blood to the kidneys). Renal artery stenosis (a narrowing or blockage of the renal artery) can contribute to hypertension (high blood pressure) and may be a major factor in the development of renal failure.

During a renal vascular evaluation, a technologist will record your blood pressure. During the ultrasound scan the technologist will pass a transducer (probe) over your abdomen and side to evaluate the blood flow in the kidneys and renal arteries. Other arteries routinely examined include the abdominal aorta, the celiac and superior mesenteric arteries.

Common symptoms indicating the need for a renal evaluation may include one or more of the following:

• Hypertension (new onset or uncontrollable)
• Renal Failure

An abdominal aortic aneurysm (AAA) is the "bulging" or "ballooning" of a segment of the abdominal aorta that is the main artery supplying blood to the organs in the abdomen and legs. An AAA can develop gradually or suddenly. Most abdominal aortic aneurysms develop over time from an accumulation of fatty deposits or other disease processes, which can cause a weakening in the vessel wall. A sudden occurrence may be due to a blunt trauma to the vessel, or a hereditary predisposition. An AAA Evaluation can determine if an aneurysm is present and provide measurements of the aorta to determine the precise location and size of the enlarged area.

Patients with an AAA may have this exam several times to determine if, and how fast, the AAA is expanding over time. During this exam the technologist will pass the ultrasound transducer (probe) over your abdomen and evaluate the abdominal aorta and any pertinent branching vessels. Remarkably, most people who have an AAA do not experience any symptoms. The presence of an AAA is often discovered incidentally during an X-ray or during an ultrasound evalauation ordered for another medical reason. Symptoms which can occur are often vague and may include one or more of the following:

• Pain in the chest, abdomen, or lower back, possibly spreading to the groin, buttocks, or legs The pain may be described as aching, gnawing, and/or throbbing, and may last for hours or days
• Pulsating or mass/lump in the abdomen.

A Mesenteric Evaluation examines blood flow in the arteries that carry oxygen rich blood to the stomach, intestines and other organs in the lower abdomen. A mesenteric artery stenosis (a narrowing or blockage of the mesenteric artery) can contribute to mesenteric ischemia, a potentially very serious condition. During the ultrasound scan the technologist will pass a transducer (probe) over your abdomen to evaluate the quality and direction of flow in the superior and inferior mesenteric arteries. Other arteries routinely examined include the abdominal aorta, celiac, hepatic and splenic arteries.

Common symptoms indicating the need for a mesenteric evaluation may include one or more of the following:

• Abdominal pain
• Chronic diarrhea
• Unexplained weight loss
• Fear of food (or pain associated with eating)

A Hepato-Portal Evaluation examines blood flow in the arteries carrying oxygen rich blood to and from the liver. The test is used to assess the quality and direction of blood flow to assist in diagnosis of portal hypertension, and identify possible portal vein and/or hepatic vein thrombosis (blood clots). During the examination, the technologist will pass a transducer (probe) over your side and abdomen to examine the blood flow in the vessels in and around the liver and spleen. Other arteries routinely examined include the abdominal aorta and the splenic arteries.

Common symptoms indicating the need for this exam may include one or more of the following:

• Esophageal bleeding (along the esophagous)
• Abdominal pain
• Abdominal distention (protruding abdomen)
• Ascites (accumulation of fluid causing abdominal swelling)
• Hepatic encephalopathy - a condition in which the brain is impaired by the presence of toxic substances that are normally removed or detoxified by the liver.

Thoracic Outlet Syndrome is due to the compression of the neurovascular structures (nerves and blood vessels) passing through the thoracic outlet. The thoracic outlet is a small space through which the main blood vessels and nerves to the arm must pass. This space is located near the base of the neck by the clavicle (collar bone). Its borders are defined by the scalene muscles in the neck that attach to the first rib and the clavicle, which lies directly above the first rib.

During a TOS Evaluation the technologist will place an ultrasound transducer (probe) at various places along the arm and evaluate the quality of blood flow. The patient will be asked to move his/her arms in various positions to determine if a significant change in blood flow occurs and/or can be elicited by certain maneuvers. The patient's symptoms are also recorded during each portion of the exam. Symptoms associated with Thoracic Outlet Syndrome include one or more of the following:

• Pain, numbness, tingling, weakness in the arm, hand, or fingers with specific motions/maneuvers (such a lifting arms overhead, pushing, pulling, etc.)
• Temperature changes, discoloration, or swelling of the hand or fingers
• Inability to grasp or hold onto objects
• Associated headaches and/or neck pain

Raynaud's phenomenon describes a condition characterized by intermittent attacks of ischemia (inadequate blood supply) to the skin. A Raynaud's "attack" or episode usually occurs during exposure to cold temperatures and primarily affects the fingers and/or toes. Blood vessels near the skin surface normally become smaller (vasoconstrict) when exposed to cold temperatures in order to conserve and reduce energy heat loss. Along the same lines, they will increase in size (vasodilate) when exposed to warm or hot temperatures. In a person with Raynaud's phenomenon however, these blood vessels will close entirely under cold temperatures and then be slower to dilate once the temperature increases.

While exposure to cold temperatures is the most common trigger to a Raynaud's episode, emotional stress or certain medications can also cause an attack. During a Raynaud's Evaluation the technologist will take your blood pressure at several different levels along the affected limb(s). Next, they will pass an ultrasound transducer (probe) over several places along the limb(s) to evaluate the quality of blood flow. Infrared sensors will be placed on the fingers/toes of interest to further evaluate the blood flow at the skin surface. This technique will be performed with the hands/feet at room temperature and then again while submerged in ice water to observe the response to cold temperature exposure. Blood pressures at the fingers/toes will also be taken during the cold exposure.

Symptoms associated with Raynaud's phenomenon include:

• Numbness or cold feeling in fingers and/or toes followed by discoloration (usually white) when exposed to cold temperatures or stress
• Pain upon re-warming of fingers/toes, usually accompanied by fingers/toes becoming blue or red
• Symptoms usually last a few minutes, but can last up to several hours

Patients who need dialysis commonly have a graft placed or fistula created in either the arm or leg that provides access for kidney dialysis. During the evaluation the technologist will pass an ultrasound transducer (probe) along the limb in which the graft or fistula is located in order to evaluate the quality of the blood flow.

Common reasons this examination may be ordered are:

• Difficulty with needle placement
• Increased dialysis time
• Pain, swelling, or discoloration of the limb or digits (fingers/toes)
• Loss of pulse in the graft
• Palpable mass in the graft or limb
• Abnormal lab values
• Increased venous pressure during dialysis