The Vascular Laboratory

Vascular laboratory! The name conjures up an image of experiments, white lab coats, and test tubes. But a vascular lab is far from that image. A vascular lab is a place for conducting examinations to identify vascular disease utilizing safe, non-invasive (no needles or dye) methods such as ultrasound. Vascular lab tests provide your doctor with important information such as whether a section of the artery has become narrowed and is causing reduced blood flow, if the valves in veins are working properly, and the presence and location of clots, inflammation, or abnormalities. There are vascular labs in hospitals, clinics, and private practices all around the world. Many vascular labs are accredited and the staff are certified. This means the lab meets certain standards and the people doing the tests must keep up with new procedures by regularly participating in continuing education programs.

Your health-care provider is the one to specify exactly what tests need to be done. You may or may not have to remove any clothing, depending on the type of test your doctor wants. In any case, wear comfortable clothing. Most of the time there is no special preparation for these tests. The examination may last 20-60 minutes, depending on what tests are being performed.

When it's time for your exam, you'll be asked to lie down and relax. For an ultrasound examination, the room may be dimmed so the technologist can easily see the monitor. Ultrasound examinations are the most common in the vascular lab because they provide reliable information about arteries and veins in a safe and painless way: no electrical currents, shock waves, needles, or dye. Ultrasound is created by tiny crystals in a transducer or handheld controller that vibrate, sending sound waves into the body. The time and quality of the echoes that bounce back to the transducer are processed into waveforms or images. To begin the examination, the technologist will put ultrasound gel on your skin in the area which the doctor wants the technologist to inspect. Ultrasound technology doesn't work well if there is air between the ultrasound transducer and your body. Gel gets rid of any air between the transducer and your skin. These ultrasound signals can also be converted into images that are displayed on a television monitor and into audible sounds that can be heard. The colors on the screen represent the moving things—such as blood. You will notice that every so often you will hear noise and then every so often you won't. That's because the technologist is "Doppler sampling," which measures how fast the blood flow is moving.

In addition to ultrasound examinations, bloodpressure cuffs might be placed around your ankles or legs as a test providing information about how much pressure is in your circulatory system. Tracings, such as EKGs, may also be taken from those same cuffs. Your doctor may request a treadmill test to see if any symptoms of "claudication" can be reproduced and measured. Claudication symptoms often include pain or aching in your legs when you walk, but which go away as soon as you stop moving. To reproduce these symptoms, you will be asked to walk on a treadmill for five minutes (or less if you cannot continue the full time). You will lie back down on the examination table and the technologist will repeat the blood pressure on your ankles and arms.

After your tests, you should not have any pain and can go about your normal activities. Your tests will need to be reviewed and interpreted, so your technologist will not be able to give you the test results that very day. The test results will be sent to your healthcare provider, who will then give you the results of the vascular lab tests. Your health-care provider will consider the examination along with your symptoms, history, your physical examination, and any other tests you may have had such as blood tests, in order to determine a diagnosis and treatment plan.

All in all, vascular testing is reliable, safe, and easy. The information from vascular tests can provide key information to your health care provider about your arteries and veins.

Keeping in Circulation is grateful to Kathleen M. Greene, MS, RN, RVT, RDMS, for assistance with this article. Ms. Greene is Technical Director, Tufts-New England Medical Center in Boston, and on the Board of Directors ofthe Society for Vascular Ultrasound.