Macon Cardio-Vascular Institute's vascular laboratory, directed by David Bammer, RT, RDMS, RVT, provides comprehensive noninvasive testing for vascular disease for inpatients and outpatients. Noninvasive vascular testing makes possible early detection and treatment of life-threatening vascular diseases such as arterial occlusive disease, stroke and deep vein thrombosis. All tests are performed by a vascular technologist with extensive specialized training on the latest equipment utilizing ultrasound technology. Advances in Doppler color flow (duplex) imaging have made possible intricate, direct anatomic imaging that allows physicians to make accurate and precise diagnoses. Our patients appreciate the convenience and ease of the tests done in our modern in-house Vascular Laboratory. Testing takes approximately 30-45 minutes to complete and requires no specia1 preparation by the patient.

CAROTID DUPLEX -As the term "duplex" implies, there are two components to the examination. The carotid arteries are visualized with ultrasound and then interrogated with Doppler to listen to blood flow and measure velocity. It is important to hear the flow and document a spectra1 display for analysis, as well as image the vessels for any plague formation. Plaque can be the cause of blood flow disturbances, ranging from mild changes to severe restriction requiring surgical intervention. Our criteria for interpretation of these examinations is based on the definitive international studies in carotid occlusive disease and has correlation of approximately 95% with arteriography, the "gold standard" for measurement of carotid stenosis.

Carotid Artery Imaging - Extracranial carotid artery imaging is one of the most common vascular laboratory studies. Improvements in technology have made this a convenient and rapid screening test for patients with cerebrovascular symptoms, for patients with asymptomatic bruits, and for patients who are about to undergo major cardiovascular surgery. The common carotid, external carotid, internal carotid, and vertebral arteries are visualized bilaterally in this study. Ultrasound makes it possible to characterize the plaque within the carotid bifurcation and to determine the hemodynamic effect of the plaque on blood velocities within the extracranial vessels.

VENOUS DUPLEX - When there is suspicion of a thrombus, phlebitis or possible weakened valves in the veins of the arms or legs, the testing procedure is a venous duplex. A thrombus is a blood clot of the vein and can be detected with a duplex examination. As with the carotid duplex, the veins are imaged and the flow is interrogated with Doppler. Mild pressure is exerted on the legs to compress the vein and then the blood flow is evaluated for a change of audible sound. As with the carotid examination, there is no discomfort.

Peripheral Venous Studies - The vascular laboratory has an established role in detecting the presence and determining the location and size of deep venous thromboses. Bedside clinical evaluation, which includes checking for limb swelling, pain, or the presence of a Homans' sign, is only 50% accurate in detecting deep venous thrombosis. The vascular lab provides direct venous imaging of the femoral, popliteal, and calf veins. Color flow imaging allows identification of occlusive and nonocclusive venous thrombi. Patients who have symptoms compatible with deep venous thrombosis can be assessed without the need for a venogram.

ARTERIAL DOPPLER - Restriction of arterial blood flow to the extremities can be determined with the use of a Doppler machine. This procedure involves placing blood pressure cuffs on the arms and/or legs. There is sometimes slight discomfort when the cuff is inflated but it is minimal and the pressure is released rapidly. In normal, healthy arterial flow, the ankles pressure is higher than the arm pressure. The ratio between the two pressures enables us to calculate the degree of atherosclerotic changes in the flow and with the use of additional cuff pressures on the legs helps to localize specific areas of flow reduction. One of the most common indications for this examination is claudication, pain in the legs induced by exercise.

Peripheral Arterial Studies - The noninvasive vascular Lab provides the measurement of lower extremity arterial pressures for the physiologic evaluation of patients with claudication, rest pain, or gangrene. This service is a quick and inexpensive means of screening for arterial disorders. Diabetic patients are at high risk for developing foot ulcerations, or gangrene, or both. Because of associated neuropathy, many diabetics do not realize that they have developed a potentially serious foot infection. The vascular lab provides physiological evaluations that determine disease severity and segmental pressures that localize the occlusive disease. Color flow imaging can be used for the direct anatomic diagnosis of lower extremity arterial stenotic or occlusive disease. The color flow image accurately surveys the status of the major arteries of the lower extremity. Color flow imaging is also excellent for the diagnosis of catheter-related complications, which include false aneurysms and traumatic arteriovenous fistula. Patients with rest pain, distal ulcerations, or impending tissue loss are good candidates for arterial reconstruction, most often utilizing saphenous vein bypass grafting. Bypassing to tibial arteries at the ankle or beyond often provides excellent results. Graft stenosis occurs in up to 20% of these patients, however, through the development of intimal hyperplasia. Doppler color flow imaging is very useful in screening bypass grafts for occult stenosis. Early detection of the technical problems that can occur after the grafting procedure makes it possible to revise the graft and prevent graft thrombosis and/or bypass graft loss.

ABDOMINAL AORTA -An enlargement or aneurysm of the abdominal aortic can be measured with ultrasound. This is a simple, non-invasive and accurate method of documenting and following patients for aneurysmal dilation.

Abdominal Vascular Imaging - Doppler color flow imaging may be used for vascular diagnosis almost anywhere in the body. One use is to aid in the diagnosis and evaluation of abdominal aortic aneurysms This noninvasive technology is useful in assessing the progression of the aneurysm and in selecting patients for interventional procedures such as endograft placement or aneurysm resection.

Noninvasive Vascular Laboratory Reports

Patients referred to the vascular lab on an outpatient or inpatient basis will have a prompt report generated and sent to the referring physician. If a serious or potentially dangerous condition is discovered, a vascular technician or physician will immediately contact the requesting physician. If you or your staff have further questions regarding a vascular laboratory test or if you are uncertain as to which vascular laboratory test is best for your patient, please call the office at (478) 743-9762.

Macon CardioVascular Institute has added a state of the art multi-slice CT scanner to its facility to improve assessing and diagnosing peripheral vascular disease. The new Brilliance CT scanner from Philips Medical Systems features advanced technology that produces split second high quality images, permitting MCVI doctors to see more anatomical detail in a fraction of the time needed for other tests. With this new CT scanner, they will be able to more effectively detect and treat peripheral vascular disease.
   The unmatched speed and sub-millimeter detail of the new CT scanner makes advanced applications such as vascular imaging routine. "We can use the extensive image information we get from the Billiance CT scanner to generate very detailed 3D images that can be used for diagnosis and also shared very quickly with referring physicians for treatment evaluation and follow-up," says Maurice Solis, MD.
   Patients needing a CT scan will find that MCVI's new scanner offers a much more pleasant experience. MCVI will provide CT scan results to patients or referring providers. Referrals may be made by calling the MCVI office at (478) 743-9762.