Vein Diagnostic Tests & Preparing for Surgery
About Dr Luke Matar
Non-invasive arterial and venous duplex studies can detect the presence, location, and severity of arterial and venous vascular diseases. These are simple, cost-effective and painless procedures performed using Doppler ultrasound techniques and no surgery, X-rays, or no needles are used.
Duplex ultrasound uses sound waves to detect how blood flows through the blood vessels and to reveal any blockages. Duplex ultrasound combines traditional ultrasound with Doppler ultrasound. Regular ultrasound uses high-frequency sound waves to create images of organs within the body, while Doppler ultrasound uses sound waves to evaluate blood as it flows through a blood vessel.
During the procedure, you are asked to lie down on a table, a gel is applied to help transmit the sound waves and a handheld device called a transducer is gently moved on the area to be examined. As the transducer moves, the signals are transmitted to the computer that changes the sound waves into images. During the test, you may hear a “swishing” sound, which is the sound of the blood moving through the body.
With a venous study, you will also be asked to stand and your calf may be squeezed to assess the direction of blood flow in your veins.
A duplex ultrasound can help diagnose the following conditions:
Peripheral Arterial Disease: Peripheral arterial disease (PAD) refers to narrowing of the blood vessels that obstructs blood flow to the arms or legs, usually due to atherosclerosis (fatty plaques in walls of blood vessels) or other diseases.
Deep Venous Thrombosis: Deep venous thrombosis (DVT) refers to a condition in which a blood clot is formed in a vein and the clot can move through the blood stream to the lungs.
Chronic Venous Insufficiency: Chronic Venous Insufficiency (CVI) refers to a situation where the valves in the superficial veins malfunction and are “leaky” leading to incorrect flow of blood in the downward direction of gravity.
Ankle-Brachial Index (ABI)
The Ankle-Brachial Index (ABI) is a non-invasive diagnostic test performed to determine your risk of peripheral artery disease (PAD), a condition of narrowing or blocking of the arteries in your legs or arms. This condition increases the risk of stroke, leads to poor blood circulation, and may cause heart attack and leg pain. The ankle-brachial index is determined by comparing the blood pressures of the ankle and the arm. A low ABI value indicates narrowing of the peripheral arteries.
In addition to determining the severity of PAD, it may also be recommended to check the efficacy of prescribed therapy (medicines, exercise, angioplasty or surgery) for PAD.
The ankle-brachial index test is performed at the doctor’s office and doesn’t require any specific preparation. You will have to lie on the table; your doctor will use a standard blood pressure cuff to measure the pressure in your arms and in two arteries near each ankle. A stethoscope or a hand-held ultrasound device may be pressed on your skin to hear the pulse. The ankle-brachial index is calculated by dividing the highest blood pressure at the ankle by the highest blood pressure at the arms. The test is sometimes performed at rest and after exercise.
If the normal value of ABI test at rest is 1.0 to 1.4, it indicates absence of narrowed peripheral arteries or blockage of blood circulation. The range of ABI values indicates the condition of arteries as below:
ABI of 0.9 to 0.99 indicates some narrowing of arteries or starting of PAD
ABI of 0.8 to 0.89 indicates early stage of PAD
ABI of 0.5 to 0.79 indicates more blockage of ankle or leg arteries with leg pain while exercising
ABI of less than 0.4 indicates severe PAD
ABI of more than 1.4 indicates stiff arteries
If you are diabetic or have chronic kidney disease, the ABI test measured by standard procedure may not be accurate due to calcification (hardening) of the arteries. In such patients, measuring blood pressure at the less rigid arteries of the toe may provide more accurate results.
A venogram is a procedure that uses X-rays to record images of the blood flowing through the veins of your body. It determines the condition of veins and looks for the source of blood clots in patients with suspected pulmonary embolism. Veins are clearly visible on the X-ray images when a special contrast dye is injected into them. Veins from various parts of your body such as legs, pelvis, arms, heart or kidney can be observed in the venogram. Computed tomography (CT) venography makes use of X-rays emitted by a CT scanner to view images of veins in various parts of the body.
You should avoid eating for 4 hours before the procedure, but continue the intake of fluids. Inform your doctor if you are pregnant, allergic to the contrast dye, have asthma, bleeding problems, or kidney problems.
You will have to lie on a table attached to a CT scanner. A contrast dye is injected for studying the veins of a particular body part. For a venogram of leg veins, you will have to relax and keep the legs still.
An elastic band will be tied to the ankle to fill the veins with blood and a contrast dye will be injected on the top of your foot. For a venogram of the pelvis, dye is injected in a vein of the groin. For a venogram of the arm, dye is injected in the arm. The CT scanner emits X-rays which records images of the particular body part. The CT scanner tilts to take images from different positions while you lie straight on the examination table.
Following the procedure, you may have to elevate the arm or leg and a sterile saline solution will be injected into the veins to flush the dye. Medications may be injected into the veins to prevent blood clotting and the site of injection is then bandaged.
Risks & Complications
As with any procedure, CT venography involves certain risks and complications. They include:
Infection or damage to the veins
Damage to cells and tissues due to X-ray radiations
Rarely, deep vein thrombosis (blood clot in the deep vein)
Preparing for Surgery & Procedure
Preparing for Surgery
Once you and your Doctor decide that surgery will help you, you will need to learn what to expect from the surgery and create a treatment plan for the best results afterward. Preparing mentally and physically for surgery is an important step toward a successful result. Understanding the process and your role in it will help you recover more quickly and have fewer problems.
Working with Your Doctor
Before surgery, your doctor will perform a complete physical examination to make sure you don’t have any conditions that could interfere with the surgery or the outcomes. Routine tests, such as blood tests and X-rays, are usually performed a week before any major surgery.
- Discuss any medications you are taking with your doctor and your family physician to see which ones you should stop taking before surgery
- Discuss with your doctor about options for preparing for potential blood replacement, includes donating your own blood, medical interventions and other treatments, prior to surgery
- If you are overweight, losing weight before surgery will help decrease the stress you place on your new joint. However, you should not diet during the month before your surgery
- If you are taking aspirin or anti-inflammatory medications or warfarin or any drugs that increase the risk of bleeding you will need to stop taking them one week before surgery to minimise bleeding
- If you smoke, you should stop or cut down to reduce your surgery risks and improve your recovery
- Have any tooth, gum, bladder or bowel problems treated before surgery to reduce the risk of infection later
- Eat a well-balanced diet, supplemented by a daily multivitamin with iron
- Report any infections to your surgeon. Surgery cannot be performed until all infections have cleared up
- Arrange for someone to help out with everyday tasks like cooking, shopping and laundry
- Put items that you use often within easy reach before surgery so you won’t have to reach and bend as often
- Remove all loose carpets and tape down electrical cords to avoid falls
- Make sure you have a stable chair with a firm seat cushion, a firm back and two arms
Preparing for Procedure
If you are having Day Surgery, remember the following:
- Have someone available to take you home, you will not be able to drive for at least 24 hours
- Do not drink or eat anything in the car on the trip home
- The combination of anaesthesia, food, and car motion can quite often cause nausea or vomiting. After arriving home, wait until you are hungry before trying to eat.
- Begin with a light meal and try to avoid greasy food for the first 24 hours
- If you had surgery on an extremity (leg or hand), keep that extremity elevated and use ice as directed. This will help decrease swelling and pain
- Take your pain medicine as directed. Begin the pain medicine as you start getting uncomfortable, but before you are in severe pain. If you wait to take your pain medication until the pain is severe, you will have more difficulty in controlling the pain