People with vascular disease have an increased risk of potentially disabling or fatal conditions including aneurysm of the aorta, the body's main artery; stroke due to blockage in the carotid arteries, which carry blood to the brain; and impaired circulation in the legs, which can lead to serious disability. In many cases these conditions can become quite serious before they produce symptoms, so detecting these diseases early can significantly reduce the risk of death and disability. NewYork-Presbyterian Hospital's Division of Vascular Surgery has a Vascular Disease Screening Program aimed at early detection of vascular diseases.
Our screening program offers the following three, painless, noninvasive tests:
- Carotid Duplex (carotid artery ultrasound scan) to detect stenosis or narrowing of the carotid arteries
- Abdominal Duplex (aorta ultrasound scan) to detect abnormalities in the aorta
- Ankle Brachial Index (test of blood flow in the legs) to detect reduced blood flow to muscles and tissues in the leg
People over 60 with one or more of the following risk factors, and everyone over 50 who has a family history of abdominal aortic aneurysm, should be screened. Risk factors include:
- High blood pressure
- High cholesterol
- Coronary (heart) artery disease
- Family history of vascular disease
- Prior stroke or "mini" stroke
- Known peripheral (non-cardiac) vascular disease
Medicare and many insurance companies do not cover the costs of vascular disease screening in people without symptoms. NYPH's Division of Vascular Surgery offers a low-cost alternative – $220 for all three tests.
Specialists at NewYork-Presbyterian Hospital often evaluate vascular disorders using one or more of a variety of imaging tests in our Noninvasive Vascular Laboratory. These tests are not painful, do not involve needles or injections, cause no discomfort, and have no side effects. Your primary care physician or vascular specialist will request the tests, and your visit with the vascular specialist usually coincides with tests in the vascular laboratory.
Carotid Duplex: This ultrasound procedure can detect carotid artery disease – blood clots, plaque build up, and other blood flow problems in the carotid arteries – early, before it causes any symptoms. When the disease is detected early vascular specialists can perform procedures that are effective in preventing stroke.
Aorta Ultrasound Scan: An aorta ultrasound exam can diagnose aneurysms that develop in the abdominal aorta, and is used to follow patients who have undergone procedures including aortic endograft and aortic open repair aneurysm.
Arterial Duplex Imaging: Using this high-frequency ultrasound test vascular specialists can visualize the arteries in the legs and the velocity and direction of blood flow in those arteries.
Treadmill Exercise Testing for Claudication: Doctors use treadmill testing to detect peripheral artery disease in patients who have pain in their lower limbs (claudication). During a treadmill test they can evaluate how exercise affects ankle-level blood pressure and analyze the relationship between claudication and vascular function.
Digital Photoplethysmography (PPG) with Thermal Measurement: Digital photoplethysmography (PPG) is an imaging test used to detect changes in blood flow at the microvascular level in the fingers and toes in people with Raynauds disease.
Ankle Brachial Index (ABI) with Pulse Volume Recordings (PVR): Doctors use these tests to measure blood flow and detect arterial blockages in the arms and legs. Together the tests help determine the presence, severity, and location of peripheral arterial occlusive disease.
Renal Artery Duplex Scanning: This imaging test evaluates blood-flow velocity and patterns in the aorta and renal arteries to help diagnose and locate blockages in the vessels and damage to the kidneys from chronically poor blood flow.
Dialysis Access Evaluation: This ultrasound exam helps vascular specialists map veins and determine which can be used for hemodialysis access.
Thoracic Outlet Obstruction Evaluation: Doctors use a combination of imaging studies including chest x rays, CT scans (in some cases with 3-dimensional reconstruction to show compression of the structures at the thoracic outlet), angiography and venography, MRI, ultrasonography, electromyography (EMG), and nerve conduction studies to diagnose thoracic outlets obstructions and determine the most effective treatment.
Vein Mapping for Arterial Bypass: Before performing surgery to perform a bypass, surgeons use preoperative ultrasound imaging to determine which vein segments might be used for bypass grafts.
Venous Ultrasound Scan of the Upper and Lower Extremities: This ultrasound exam shows blood flowing through blood vessels and can be used to detect deep vein thrombosis (DVT) and superficial vein thrombosis (SVT).
Diagnostic Tools and Technology
Diagnostic Angiography: Angiography is a type of imaging test that allows doctors to view blood vessels throughout the body and diagnose blockages, enlargements, clots, and malformations. An angiogram to study the arteries is called an arteriogram; one to study the veins is called a venogram.
CT Scans: A computed tomography (CT or CAT) scan is a noninvasive imaging test in which computers combine special x-ray images to produce cross-sectional images of internal organs, bone, soft tissue and blood vessels, allowing radiologists to diagnose vascular problems.
TeraRecon/Aquarius: This new technology allows vascular specialists who are planning an endovascular stent graft repair of an aortic aneurysm to create and analyze a three-dimensional reconstruction of a computed tomography angiogram. These images help ensure proper sizing and placement of the graft.
MRI: Magnetic resonance imaging (MRI) uses a powerful magnetic field, radio frequency pulses, and a computer to produce detailed pictures of organs, soft tissues, bone and virtually all other internal body structures. Detailed MR images allow physicians to better evaluate various parts of the body and certain diseases that may not be assessed adequately with other imaging methods such as x-ray, ultrasound or computed tomography (also called CT or CAT scanning).
Zeego: Specialists at NewYork-Presbyterian now use a new vascular imaging system (Zeego) that employs X-ray technology to image blood vessels. This angiography system allows doctors to move a C-shaped arm to almost any position around the patient, and to visualize internal organs from all sides.
Dyna CT: This new system allows vascular specialists to create CT-like images of soft tissue, and enables them to differentiate between normal and abnormal tissue to visualize, for example, brain tissue and intracranial hemorrhages.
Smoking Cessation Programs
Today, most people are aware that smoking is a significant risk factor for heart and vascular diseases including lower extremity vascular disease, aortic aneurysms, and carotid artery disease and stroke. If you are trying to give up smoking, speak to your physician about ways to quit. Formal smoking cessation programs are an effective option.
For more information, please see NewYork-Presbyterian's page on smoking cessation.
Cholesterol Reduction Programs
High cholesterol levels in the blood (hypercholesterolemia) can lead to atherosclerosis (deposits of plaque in the blood vessels) and vascular diseases. Maintaining appropriate levels of "good" cholesterol ("high density lipoprotein, or HDL) and "bad" cholesterol (low density lipoprotein, or LDL) in the blood is crucial for vascular health. While genetics can play a part in person's cholesterol balance, blood cholesterol levels can be improved by diet changes, regular exercise, and in some cases cholesterol-lowering medications. If your cholesterol level puts you at risk for vascular diseases here are two programs that may be helpful:
Comprehensive Lipid Control Center: The Comprehensive Lipid Control Center (CLCC), run by the Rogosin Institute, is an affiliate of NewYork-Presbyterian Hospital. The CLCC provides individualized diagnosis and treatment of high cholesterol problems. For more information about the center contact the CLCC directly by phone at (212) 702- 9600 or visit www.rogosin.org.
Nutritional Counseling: NewYork-Presbyterian Hospital/Columbia University Medical Center offers nutritional counseling and education for patients with conditions including abnormal cholesterol and high blood pressure. A referral from a physician is required. For information, call (212) 305-5952.
Exercise and Weight Reduction Programs
Consistent moderate exercise promotes vascular health by improving blood circulation in the peripheral vascular system and by helping to maintain a healthy blood pressure and body weight. A healthy body weight is best achieved through a combination of proper diet and exercise. Always check with your doctor before beginning a new exercise program. Exercise and weight management programs accessible to our patients are listed below:
HealthOutreach: HealthOutreach, a program for people over 60 years of age, conducts a number of exercise classes. One 10-session class is located at Sokol Hall, 1325 York Street. For more information, call (212) 746-4351
Weight Management Program: The Department of Food and Nutrition at NewYork-Presbyterian Hospital/Weill Cornell Medical Center offers an 8-week program in weight management, which addresses life-style changes for weight loss and long-term weight management. For information, call (212) 746-0850.