Our Range of Services
IVS offers comprehensive range of non-invasive and minimally invasive specialist vascular ultrasound diagnostic services to our clients. Our staff actively seek to improve current diagnostic methods and to develop new protocols for the diagnosis of vascular disease.
Our staff influence and review NICE guidelines as part of Professional Standards Committee for the Society of Vascular Technology or Great Britain and Ireland.
Carotid artery Duplex scan is performed to determine if the blood vessels providing the circulation to your face and brain are open and do not have blockages (occlusion) or narrowing (stenosis). The test is often performed before surgical procedures, if your have experienced any symptoms of stroke or to assess how well surgery on the arteries in your neck has gone.
Plaque, which is a build up of fatty materials such as cholesterol and triglycerides, thrombus accumulation (blood clot), and other substances in the blood stream may cause a disturbance in the blood flow through the carotid arteries.
Symptoms of stroke (CVA) or mini-stroke (TIA) are most easily recognised by FAST – Face-Arms-Speech-Time.
- Face – the face may have dropped on one side, the person may not be able to smile or their mouth or eye may have drooped
- Arms – the person with suspected stroke may not be able to lift one or both arms and keep them there because of arm weakness or numbness
- Speech – their speech may be slurred or garbled, or the person may not be able to talk at all despite appearing to be awake
- Time – it is time to dial 999 immediately if you see any of these signs or symptoms
Source: NHS Direct 2013.
What will Happen?
- Clothes can be kept on, although we will need to have access to your entire neck and collarbone.
- Some water based gel, which may feel cold, and a probe will be placed onto your neck (see above image).
- Images will appear on the screen of your blood vessels, similar to the picture below.
What is DVT?
DVT or Deep Vein Thrombosis is a blood clot that forms in a deep vein in the body, commonly in the legs. These clots become dangerous if the clot loosens and is carried by the blood to elsewhere in the body (e.g. the lungs) and causes a blockage in an artery.
What is superficial thrombophlebitis?
When blood clots form in the superficial veins, which lie just under your skin, the condition is known as superficial thrombophlebitis. These superficial blood clots are different to DVT and are much less serious, although they can occasionally spread to deep veins. Superficial thrombophlebitis does not normally require anticoagulation treatment and often resolves on its own within 3-4 weeks.
DVT Risk Factors
DVT can occur in almost anyone. Only about half of all patients with DVT have symptoms. However, certain individuals may be at increased risk for developing a DVT. Risk factors include but are not limited to:
- Restricted Mobility
- Congestive Heart Failure
- Respiratory Failure
- Infectious Disease
- Age > 40
- Prior or family history of venous thromboembolism (VTE)
Diagnosis of DVT
Usually, when a DVT is suspected, patients are asked a number of questions about the circumstances surrounding their symptoms (e.g. length of time and nature of symptoms) to assess their risk of having a clot. At the same time, you may have some blood taken for a test (called a D-dimer test) that looks for chemical evidence of clots in your blood. An ultrasound scan is needed to identify the presence and position of a clot. The images of the veins generated on the screen will allow your Vascular Scientist to see whether a clot is present and how extensive it is.
Pictures below show typical appearance of a thrombus (positive DVT) in a vein. Appearance of a thrombus varies depending on the age, extend and location of the clot.
Treatment of DVT
Anticoagulant medicines are the standard treatment for DVT. They change chemicals in your blood to stop clots forming so easily. Anticoagulants include heparin and warfarin. Anticoagulants can stop new blood clots from forming and old ones from getting any bigger. They can’t dissolve clots that you already have – your body will do that itself over time.
Varicose veins are dilated, often palpable subcutaneous veins with reversed blood flow. This happens because small valves inside the vein are not working properly allowing venous blood to go back the wrong way. This is called venous reflux. Varicose veins are most commonly found in the legs.
Visible varicose veins in the lower limbs are estimated to affect at least a third of the population. In some people varicose veins are asymptomatic or cause only mild symptoms such as aching and itching at the end of the day, but in others they can cause chronic pain, skin changes and superficial thrombophilebitis which can have a significant effect on quality of life. Varicose veins may become more severe over time and can lead to complications such as changes in skin pigmentation, bleeding or venous ulceration. Pregnancy, being overweight and old age may increase the risk of developing varicose veins.
Images showing extensive lower limb varicose veins & Spectral Doppler reflux in a long/great saphenous vein.
An abdominal aortic aneurysm (AAA) is a dilation of the main blood vessel in the abdomen due to a weakening of the vessel wall. This condition is seen in men and women, but the risk increases with age and certain risk factors (smoking, high blood pressure, family history). It is most common in men aged 65 or over, and as such this group is automatically invited to attend a screening test as part of a national screening programme.
AAAs can be detected using duplex ultrasound by viewing the aorta and measuring the distance between the walls of the vessel to determine whether it is within a normal range of sizes.
In order to look at this artery, you will be asked to lie on a bed and expose your abdomen (normally from just below the ribs to just above your waistline). The vascular scientist will then look at the artery starting just below the ribs and follow the vessel down to around the level of your belly button – taking measurements of the arteries diameter.
It may not be possible to see the artery along its full length if it is obscured by bowel gas. This occurs in some patients regardless of their diet, and is a common problem when scanning the abdomen because we are scanning through the bowels. If this occurs, the Vascular Scientist performing your scan might attempt to scan your abdomen from different positions, and/or ask you to move into a different position (for example, onto your side).
Image 1. Large Abdominal Aortic Aneurysm
Image 2. 3D reconstruction of an Abdominal Aortic Aneurysm
Contrast enhanced ultrasound (CEUS) following endovascular aneurysm repair (EVAR)
Abdominal aortic aneurysms (AAA) occur when the wall of the aorta (the largest artery in your body) becomes weakened, resulting in it expanding to form an aneurysm. This can enlarge and develop into a potentially serious health problem. This can be fatal if the aneurysm becomes so enlarged it bursts. The normal diameter of the aorta is approximately 1-2cm. It is considered aneurysmal when it expands to over 3cm and is considered to require intervention when it expands to 5cm women and 5.5cm in men. IVS ltd are proud to be involved in the aneurysm screening program to screen men and women over the age of 65 for aneurysms. If aneurysm is detected then IVS ltd will continue to monitor the size of the aneurysm at subsequent visits to our clinic. If any intervention is required patients are referred to the relevant physician.
Endovascular stent grafting, or endovascular aneurysm repair (EVAR), is a new innovative form of keyhole surgery for the treatment of abdominal aortic aneurysms. It is less invasive than open surgery and uses an endovascular stent graft to reinforce the wall of the aorta to help keep the damaged area from rupturing. Endovascular means the inside of your blood vessel. Not all patients are suitable for this type of surgery, depending on the size and position of the artery.
Patients subsequently attend clinic run by IVS ltd for follow up scans to ensure that no complications have occurred. These can involve leaks into the aneurysm and are called ‘endoleaks’. This can occur from a gap in the adjoining sections of the stent graft, movement ‘migration’ of the graft from the desired location of a leak into the aneurysm from a surrounding artery that has not been isolated during the procedure. This investigation will involve an EVAR duplex ultrasound scan. This scan is a simple, non-invasive procedure involving some gel placed on your skin and the ultrasound probe used to image the EVAR stent graft. If a leak is detected the referring physician then decided whether and intervention needs to be taken. IVS continues to closely monitor our patients following EVAR throughout the time that the graft is in place.
IVS works closely with both NHS and private hospitals at multiple sites across the north of England.
Contrast Enhanced Ultrasound
Recent advances in medical research have developed a more advanced type of EVAR imaging using ultrasound. This is with the addition of a contrast enhancement agent. The contrast agent can be administered to the patient through a simple cannula in the arm or hand. The agent is made up of tiny microbubbles which act to strongly reflect the ultrasound to form a much more enhanced brighter image for us to analyse. This enables even more precise information as to if there is a leak present and, if so, it’s origin.
IVS is now also providing this service to our patients along with the standard EVAR duplex.
We are currently training all of our Vascular Scientists in this new modality in order to develop and maintain our expertise in this field. In a continued effort for the future we plan to research and develop all up and coming modalities and resources to ensure that we continue to provide the best possible patient care.
Duplex ultrasonography of the legs involves looking at the arteries along the length of the leg, usually from abdominal aorta to the ankles and assessing the blood flow within them. This will identify narrowing or blockages within the arteries caused by atherosclerotic disease or blood clots; or other abnormalities of the arteries that may affect blood flow through the leg.
Reasons you may be referred for a lower limb arterial duplex scan include: pain in the legs at rest (called rest pain) or during and after exercise (called intermittent claudication). Lower limb arterial disease causes either acute or chronic limb ischemia.
The scan will usually start at the abdomen or groin, and follow the arteries throughout their course in your legs down to the ankle – and the blood flow is evaluated by imaging the vessels throughout the limb.
After the scan is complete, you will have your blood pressure taken in both legs.
Popliteal artery entrapment syndrome (PAES) is a rare developmental defect in which the gastrocnemius muscle, popliteus muscle or tendons neighbouring the popliteal fossa are abnormally formed and can cause extrinsic compression of the popliteal artery when the lower limb is maintained in certain positions. Over-development of the gastrocnemius muscle can produce similar entrapment of the popliteal artery, and is often observed in professional athletes or in those with professions that require physical activity.
Patients with PAES commonly present with intermittent calf claudication or parasthesia and symptoms are normally exacerbated upon exercise. Since the patient demographic of those suffering from PAES is typically young athletic individuals, the symptoms are often likely to be attributable to musculoskeletal disorders rather than vascular disease. However, differential diagnoses can include a number of lower limb disorders such as peripheral vascular disease, cystic adventitial disease, arterio-venous fistulae, compartment syndrome, muscle rupture, neuropathy and venous thrombosis.
If left undiagnosed, prolonged exposure to PAES can result in micro-trauma to the popliteal artery, and can ultimately lead to localised stenosis, aneurysms or complete occlusion.
If PAES is suspected IVS can perform a full arterial assessment of the lower limb and perform dynamic positional imaging in extreme plantar flexion and dorsiflexion positions.
Figure 1: Occlusion of the left popliteal artery identified through duplex ultrasound colour-flow imaging identified in patient with suspected PAES.
Duplex ultrasonography of the arms involves looking at the arteries along the length of the arm (from the shoulder to the wrist) and assessing the blood flow within them. This will identify narrowings or blockages within the arteries caused by atherosclerotic disease or blood clots; or other abnormalities of the arteries that may affect blood flow through the arm.
Reasons you may be referred for an upper limb duplex scan include: pain in the arms at rest or after exercise; pain or numbness whilst holding one or both arms in a particular position; suspected blockage of the artery caused by a blood clot; aneurysm; arterio-venous fistulas (usually renal patients) and planning for surgery or monitoring of a previous surgery (such as a graft placement or angioplasty).
The scan will usually start at the neck, and follow the arteries throughout their course in your arm down to the wrist – and the blood flow is evaluated by imaging the vessels throughout the limb.
After the scan is complete, you may have your blood pressure taken in both arms to check that they are similar. If there is a difference in blood pressure between the arms, this may indicate that there is a problem with the flow of blood in one of them.
If the reason for the scan was because of pain or numbness felt when the arm is in a particular position, then you may have an additional test performed at the scan called a Thoracic Outlet Test.
Thoracic Outlet Syndrome is a condition associated with compression of the blood vessels in the shoulder, and may be caused by an excess band of muscle or bone that puts pressure on the artery and restricts blood flow to the arm.
The purpose of the test is to identify whether there is any compression of the artery occurring when the arm is in a particular position. The Vascular Scientist performing the scan will assess this by moving your arm into different positions whilst listening to the pulse.
- Pelvic congestion syndrome.
- Vulvar and vaginal varicosities.
- Recurrent lower limb varicose veins.
Chronic pelvic pain in otherwise healthy multiparous females can be caused by dilation of pelvic veins leading to congestion of the ovarian plexuses and broad ligaments. Over the years some studies have demonstrated that otherwise unexplained pelvic pain can be caused by dilation of major pelvic veins in more than 80% of cases.
New or recurrent varicosities in the vagina or vulvar area spreading into the inner upper thigh or back of the thigh can often develop as a consequence of multiple pregnancies. It is estimated that this condition may affect as many as 15% of women.
Unfortunately to patients this condition is not well known. Most surgeons would simply treat the visible varicosities in the legs leaving the potential pelvic source of these veins untreated.
The Team IVS has developed a one-stop service to provide fast and effective diagnosis of pelvic and vulvar varicosities using the latest non-invasive techniques. If a possible pelvic vein reflux (internal iliac vein or ovarian vein) is suspected during initial clinical assessment or during a routine Duplex scan of the leg veins, we can perform a simple transvaginal (internal) pelvic ultrasound to assess these veins. In order to perform this scan it is necessary to gently insert the tip of an ultrasound probe into the vagina. It will be covered with a protective sheath and lubricating gel. This is a simple and usually painless procedure and usually takes no longer than 20 minutes. The probe is a little bigger than the size of a finger or a tampon. The examination should not be painful or distressing.
With IVS all internal scans are performed by an accredited female Senior Clinical Vascular Scientist. A report will be forwarded to your surgeon who will provide a full treatment plan.
Fig 1 – Perivulval varices may extend over the buttock and particularly across the back of the thigh, and after several pregnancies, they persist and may communicate with the greater saphenous vein, which is then involved even when the sapheno-femoral junction is competent or has been previously ligated. Occasionally, even the short saphenous vein is involved via the Giacomini vein on the back of the thigh.
Fig 2 – Vulvar varicose veins extending over the buttocks. These are often referred as “atypical” varicose veins.
Fig 3. Image showing reflux in a pelvic varicose vein using transvaginal ultrasound.
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