Our non-invasive vascular lab is located in the Boston Vein Care Chelmsford office, and it provides a comprehensive list of diagnostic tests. Our services are designed with both the patient’s comfort and referring physician's convenience in mind. We try to accommodate many of the requests for tests on the day of referrals. A report is generated and faxed to the referring provider, and uploaded on the patient portal for 24/7 patient access. A few of the most commonly performed tests are listed below. If you have further questions on what tests we conduct in our lab please call us to ask.
ARTERIAL & VENOUS ULTRASOUND:
Physiological non-invasive tests like ABI & segmental pressures are time tested screening tests for peripheral arterial disease (PAD). However, these tests also have relatively high false negative rates (a test comes back negative even though the patient actually has the disease). For this reason, arterial ultrasounds are often used. Similarly, venous-ultrasounds are the gold standard for diagnosing venous reflux, and deep venous thrombosis.
At Boston Vein Care, we perform both upper and lower extremity arterial ultrasounds. As long as we have an appropriate request, we can perform subsequent tests according to our lab protocol to definitively diagnose or out rule the suspected condition to save time patient and referring physician’s time.
ABI, TBI & SEGMENTAL PRESSURES:
- ANKLE BRACHIAL INDEX (ABI)- First in line as a basic screening test for PAD.
- TOE BRACHIAL INDEX (TBI)-Primarily used in patients with hardened arteries in diabetic and/or elderly patients.
- SEGMENTAL PRESSURES- To help localize blockage in an arterial segment.
- PHOTOPLETHYSMOGRAPHY (PPG)- Usually done in conjunction with ABI & TBI to increase the accuracy of above-mentioned tests.
Unlike many other offices, we perform a stress test by strictly following the guidelines recommended by CMS and the Society of Vascular Medicine. The patient will walk on a treadmill at an inclination of 10 degrees at a speed of 1.5 miles per hour for 5 minutes (unless pain forces a patient to stop). We report the distance the patient was able to walk before the onset of pain, the total distance walked, the drop in ABI, and the time it took for ABI to go back to baseline.
The data from this standardized test not only gives information about the extent of PAD, it can also be used to plan treatments and outcomes. The baseline exercise test can be compared with future tests to determine whether a patient’s walking distance has improved or worsened. These comparison reports will be available for the referring physician as well. It is not possible to get accurate follow-up data from non-standardized tests like heel raises or walking in a hallway. For this reason, CMS will not reimburse a non-standardized test as an exercise test.
STROKE (CVA) SCREENING:
Carotid artery stenosis is one of the most important causes of mini strokes (TIA) and full-blown strokes (CVA). Additionally, the inner wall thickness of the carotid artery (Carotid Intima Thickness) is used as a cardiovascular screening test. We perform this test by request of the primary care providers in patients with a history of sub-acute stroke (acute stroke is usually best managed in hospital settings).
RENAL ARTERIAL DUPLEX:
The presence of high blood pressure in relatively young patients warrants the need to exclude secondary hypertension. The renal arterial blockage is one of the more common causes of secondary hypertension in young adults. Additional “red flags” for a renal arterial disease could be difficulty controlling blood pressure or renal impairment in a patient with high blood pressure at an early stage, or deterioration of kidney function after initiation of ACE or ARB inhibitors. Ideal patients for this test have a relatively normal body mass index, however mildly overweight patients can also have this diagnostic test done after fasting for about 6 hours. This test has the advantage of being non-invasive and avoids contrast, which can sometimes compromise kidney functions.