Abdominal Vascular Duplex Evaluations
The abdominal aorta is scanned from the proximal to distal segments to determine the presence or absence of an aneurysm. AAA is a dilated segment of the aorta with a cross-sectional diameter measuring greater than 3 centimeters.
This study can determine whether an aneurysm is infrarenal or suprarenal and if there is any thrombus or heterogeneous plaque within the dilated lumen. The AAA exam is useful for endograft surveillance or follow-up of known AAA.
Clinical Indications:
- Medicare Screening for high risk patients (see Medicare benefits)
- Follow-up of known AAA
- Post-endograft surveillance
- Symptomatic
- Pulsing feeling in the abdomen.
- Severe, sudden pain in the abdomen or lower back.
- Pain, discoloration, or sores on the toes or feet due to peripheral embolization
Hypertension affects over 20% of the adult population. Renovascular disorders are among the rare secondary causes of hypertension and include renal arterial lesions from either atheroma or fibromuscular dysplasia. Other findings in the renal vascular exam may include intrinsic renal parenchymal disease, mesenteric stenosis or extrinsic compression, renal vein thrombosis, and aneurysm.
Clinical Indications:
- Hypertension (new onset or uncontrollable)
- Follow-up post PTA/stenting
- Follow-up bypass grafting
- Follow-up renal allograft
Duplex/color scanning is utilized to evaluate renal artery and kidney parenchymal blood flow for hemodynamically significant renal artery stenosis (greater than 60%) and occlusions. Changes in renovascular resistance within the kidney parenchyma associated with the presence of intrinsic renal parenchymal disease are evaluated, and information regarding kidney size and related structural abnormalities is also provided. Examination of the abdominal aorta, the origins of the celiac and superior mesenteric arteries, and patency of the renal veins are routinely included.
Renal allografts are evaluated for acute renal transplant rejection, acute tubular necrosis, renal artery stenosis, renal vein thrombosis, arteriovenous fistula, perinephric fluid accumulations and hydronephrosis.
Of the three intra-abdominal branches supplying the majority of flow to the gastrointestinal organs, an acute obstruction has a very dramatic clinical presentation and requires immediate measures with elevated patient risk. A less severe chronic flow restriction allows for the development of collateral vessels, yet may result in the more intermittent symptoms seen below.
Clinical Indications:
- Abdominal pain associated with eating
- Fear of food
- Chronic diarrhea
- Unexplained weight loss
Duplex/color scanning is utilized to evaluate the celiac, superior mesenteric, and inferior mesenteric arteries for hemodynamically significant stenosis (> 70%) and occlusions. Celiac artery compression by the arcuate ligament can also be diagnosed. The abdominal aorta and the hepatic and splenic arteries are also examined.
Often, patients with suspected pathology within the liver have other disease processes at work and may present with complicated symptoms. Pacific Vascular evaluates the vasculature that feeds and drains the liver, determines the direction of the portal vein flow (whether hepatopetal or hepatofugal), and identifies portal vein thrombosis, hepatic vein thrombosis, and patency and status of porto-systemic shunts and TIPS (transjugular intrahepatic portosystemic shunts).
Clinical indications:
- Suspected portal hypertension with esophageal/bleeding varices
- Abdominal pain
- Abdominal distention
- Ascites
- Hepatic encephalopathy
- Venous hum
- Cruveilhier-Baumgarten Syndrome
- Budd-Chiari Syndrome with sudden abdominal epigastric pain with nausea and vomiting
- Hepatomegaly
- Splenomegaly
- Abdominal collateral vein distention
- Follow-up post porto-systemic shunting (including TIPS- transjugular intrahepatic portosystemic shunting).
Duplex/color scanning is utilized to examine the inferior vena cava, left and right renal veins, splenic vein (as well as the spleen), portal vein (main, left, and right), hepatic vein (left, middle, and right), and the hepatic artery. Specific objectives include assessment of flow quality and direction to assist in diagnosis of portal hypertension, identification of portal vein and/or hepatic vein thrombosis, and evaluation of flow quality and direction in patients with porto-systemic shunts.
The technical quality of all abdominal vascular studies is significantly affected by patient body habitus and presence of abdominal gas. Fasting is recommended for this exam. No food or drink 8 hours prior to test to minimize bowel gas. Medications per usual. Diabetics eat and medicate per usual, the minimum amount to keep blood sugar stable. If abdominal blood vessel visualization is poor, you may be asked to return at a later date.
