Vascular Diagnostics & Procedures

An abdominal aortic aneurysm (AAA) is a bulge that forms in the aorta, which is the main blood vessel that carries blood from the heart to the rest of the body.

An AAA can increase in size very slowly over a period of years, or even decades. It may require emergency life-saving surgery if there is a sudden change, or if a newly-diagnosed AAA is larger than a certain size.

In many cases, people with AAA do not experience any symptoms, and the aneurysm is discovered during routine medical tests.

However, in some cases, AAA can cause symptoms such as:

• A pulsating sensation in the abdomen
• Pain or tenderness in the abdomen or lower back
• A persistent, unexplained backache
• Loss of appetite
• Feeling generally unwell or tired
• Sudden onset of severe pain in the abdomen or back, which may indicate a ruptured AAA

A narrowing or blockage of the carotid or vertebral arteries can cause stroke. The medical term for a stroke is a CVA, which stands for Cerebro-Vascular Accident. 

Deep vein thrombosis (DVT) is a condition in which a blood clot forms in one of the deep veins in the body, typically in the leg. The blood clot can block the flow of blood through the vein, which can cause swelling, pain, and discomfort. If the blood clot breaks off and travels to the lungs, it can cause a serious condition called pulmonary embolism (PE), which can be life-threatening. 

The subclavian artery is a large blood vessel that supplies blood to the upper body, including the arms, head, and neck. It rises from the aorta (the main artery that carries blood from the heart) and extends upward. The left and right subclavian arteries are responsible for carrying about a third of the blood that flows to the brain.

This stands for Transient Ischemic Attack, and refers to when blood flow to a part of the brain stops for a brief period of time. During a TIA you can have stroke-like symptoms for up to 1-2 hours.

The thoracic outlet is a small space between the collarbone and the first rib. Thoracic outlet compression syndrome (TOCS) is a condition where the blood vessels or nerves in this area become compressed or pinched.

TOCS can cause a range of symptoms, including:

• Pain or discomfort in the shoulder, neck, arm, or hand
• Weakness or numbness in the arm or hand
• Swelling or discolouration of the arm or hand
• Tingling or a pins-and-needles sensation in the arm or hand
• A feeling of heaviness or fatigue in the affected arm or hand

The condition can be caused by a number of factors, including injury, poor posture, repetitive motions, or anatomical abnormalities. Treatment options for thoracic outlet compression syndrome may include physical therapy to strengthen the affected muscles, medication to relieve pain or inflammation, or surgery to relieve pressure on the compressed blood vessels or nerves.

Varicose veins are enlarged, twisted veins that are sometimes seen on  legs and feet. They occur when the valves in these near-surface veins weaken or fail. This causes blood to pool in the veins, and leads to their characteristic bulging appearance. Varicose veins can be blue or purple in colour, and may be accompanied by symptoms such as aching, swelling, or a feeling of heaviness in the legs. 

Once you've been referred, you'll receive an appointment from our consultant vascular team.

You'll be seen as an outpatient in one of our dedicated suites. We may need to run some diagnostic tests when you come in. These will be conducted in our Vascular laboratory or in our Radiology department. 

Following your diagnosis, we'll meet with you to agree the best course of treatment.

Our surgical team provide a full range of diagnostic tests and surgery required to diagnose and treat your vascular or arterial disease.

An Ankle-Brachial Index (ABI) test is done by our cardiology teams to check for peripheral artery disease (PAD). Peripheral Arterial Disease results in reduced blood flow, or a blockage, in the arteries in your legs.

During the test, a blood pressure cuff is placed around your ankle and inflated to measure the blood pressure in that area. The same process is then repeated on your arm, to get a comparison reading.

The blood pressure readings are then compared, and if the blood pressure in your ankle is lower than the blood pressure in your arm, it may indicate that there is a blockage in your arteries.

This test is non-invasive, painless, and takes about 15-30 minutes to complete. It is often used to diagnose PAD, which can increase your risk of heart attack and stroke.

This test is performed if you have leg pain when exercising, but your ABI is normal when resting. A normal ABI after exercise is an excellent indicator that there is no lower limb arterial disease.

If there is a reduced ABI, a lower limb arterial duplex scan may be carried out. This diagnostic study takes an image of the arteries which may be narrowed or blocked. 

In some cases, before a vascular or endovascular operation on the lower limb, we do a pre-op duplex scan and then mark the position of any blockages or narrowing directly on your skin.

A Duplex, or Duplex Ultrasound, scan is a non-invasive test which uses high frequency sound waves (ultrasound) to examine internal structures. A Carotid Artery Duplex gives an image of the Carotid artery and the vertebral arteries. These are significant arteries of the neck going to the brain. This test assesses the flow of blood to the brain, and looks for plaque deposition and general quality of your blood flow.

The medical term for a stroke is a CVA, which stands for Cerebro-Vascular Accident. A negative carotid duplex scan shows that the likelihood of a CVA starting in the scanned arteries is extremely small. As a matter of routine, we study both your vertebral and carotid arteries during this test.

A duplex scan is a non-invasive scan. It assess the shape and level of blockage in your aorta, and in particular, measures the diameter of the aorta. The abdominal aorta is the largest artery in the abdominal cavity. This vessel may also become narrowed or blocked - but a more common problem is a dilatation of the artery, which is known as an Abdominal Aortic Aneurysm (AAA or Triple A.) 

An Endo-Vascular Aneurysm Repair of an AAA is commonly called an EVAR. Before this surgical procedure can take place, we must measure the main arteries of the pelvis - the iliac and common femoral arteries. This test assesses these arteries and confirms that they are free of significant narrowing. 

This is a non-invasive diagnostic study to evaluate blood flow, or perfusion, of your upper limbs. Similar to an ABI, we also usually perform this test to measure blood flow and blood pressure in your fingers. 

Even if the pressure in the arteries of the arms is normal, it is sometimes necessary to carry out TOC studies. This test helps rule out mechanical obstruction of the arteries when you move. A number of different tests can be used to help diagnose thoracic outlet syndrome. These include duplex or ultrasound scans, CT scans, MRI scans and X-rays. Your doctor might also order an arteriogram, whereby a catheter is inserted into the groin and threaded through the bloodstream, to show an image of the arteries. 

If there is a blockage in the subclavian artery (Subclavian stenosis), not enough blood will reach the arms. Symptoms may be evident when the arms are active, when more blood flow is required. A Duplex, or Duplex Ultrasound, scan is a non-invasive test which uses high frequency sound waves (ultrasound) to examine internal structures. We use this scan to examine  your subclavian artery to check for any blockages.  We carry out this test if you have an abnormal upper limb arterial pressure, or if we find you have uneven brachial pressures (>10mmHg) during another test.

It may sometimes be necessary to assess the arterial circulation in the rest of the upper limb. We'll carry out this test if upper limb arterial pressures and carotid-subclavian duplex have already been carried out, and they have not provided a conclusive result.

Duplex ultrasound is an excellent method of detecting and monitoring a Deep Vein Thrombosis (DVT). This test is a non-invasive procedure which assesses blood flow, or blockage, in the deep veins of your leg.

The most common use of this test is to detect and map varicose veins. When we carry out an assessment of varicose veins, which run close to the surface of the skin, we also look at your deep veins. The venous duplex scan gives valuable information about the blood flow in your veins, and in particular if there is back-flow of blood due to faulty valves.

Colour Doppler scanning of varicose veins is a diagnostic test to evaluate the blood flow in the veins and to identify any abnormalities. During the test, a small hand-held ultrasound device called a transducer is placed over the affected veins. The transducer emits high-frequency sound waves that bounce off the blood cells in the veins, creating images on a screen. The test also uses colour-coded images to show the direction and speed of blood flow in the veins. This can help identify areas of blockage or reflux - where blood flows backward in the vein. The physiologist will squeeze your calf and thigh muscles in turn, while you are standing up. When compression is applied to the leg muscles, the amount of colour will increase, and then should reduce when it is relaxed. The procedure is non-invasive and painless, and usually takes less than 30 minutes. It is often used to help diagnose the underlying cause of varicose veins and plan for treatment.

Arterial Angioplasty is where a surgeon will insert a balloon or a stent to open blockages in arteries around the body. While this may be a Day Case procedure, an inpatient stay of 1-2 nights might be needed. A General Anaesthetic is not always required.

Patients who benefit from this procedure have usually experienced Claudication. This is a condition where discomfort or tiredness is felt in the limbs after short exertion or walks. This condition is caused by a hardening and narrowing of the arteries supplying blood to these limbs.

An AV Fistula is a connection made between an artery and vein, most usually for patients about to undergo dialysis.  Before the surgery to insert this connection, your arteries and veins will be assessed, to ensure they are suitable for the procedure. Having an AV fistula requires a surgical operation. This can be done under general anaesthetic or regional anaesthetic (numbing the arm only). In either context, creating an AV Fistula is usually a day case procedure.

Carotid Endarterectomy is a surgical procedure to remove plaque which could cause a blockage in the carotid artery and interrupt the flow of blood to the brain. You may be assessed for this in advance of heart surgery or if you have suffered an unexplained Transient Ischemic Attack. This operation is performed under general anaesthetic and requires hospitalisation for 1-2 nights afterwards. Your surgeon makes an incision in the neck, over the carotid artery, and opens the artery to remove the plaque or clot. The artery is then repaired with stitches, or may need a patch which can be synthetic or natural material.

This is a highly successful day-case procedure to treat varicose veins. It can be performed under general anaesthetic, sedation, or occasionally just local anaesthetic. Prior to the procedure, an ultrasound scan is performed. This guides a catheter into position within the vein, through which a tiny laser is passed. The laser delivers short bursts of energy which heat and seal the vein.

An EVAR is minimally invasive surgery, using a stent to treat an Abdominal Aortic Aneurysm (AAA). You may require EVAR if you  had symptoms of AAA, or you have had your AAA diagnosed coincidentally while being scanned for something else. 

During the procedure, a catheter is inserted through a small incision in the groin and guided up to the site of the aneurysm in the aorta. A stent-graft, which is a small metal mesh tube covered in fabric, is then placed inside the aneurysm to provide support to the weakened aortic wall and prevent it from rupturing. The stent-graft is secured in place and the catheter is removed, leaving the stent-graft in place to provide a new pathway for blood flow.

The procedure is minimally invasive and is performed under local anesthesia. It usually takes a few hours to complete, and patients may need to stay in the hospital for a few days for monitoring and recovery. 

Following an EVAR surgery, the graft and the aneurysm sac must be followed up at regular intervals.  Our team will assess the ongoing effectiveness of the procedure, and will look for any leaks in the stent-graft.

Sclerotherapy is usually suitable for people who have small to medium sized varicose veins and involves an injection of solution directly into the vein. The solution irritates the lining of the vessel, causing it to scar and seal. Over time, the scar tissue fades and becomes less conspicuous. The procedure is simple, but like all surgery, can have complications. This procedure is usually carried out under local anaesthetic.

Once a vascular graft or bypass is put in place you will be checked at regular intervals to see if it is free of narrowing or blockage. This aids early intervention in the case of a problem and results in good long-term outcomes.

Once a peripheral angioplasty with or without stents is carried out, you will be checked at regular intervals to see if it is free of narrowing or blockage. This aids early intervention and results in good long-term outcomes.

A temporal artery biopsy is a test which requires a minor surgical procedure, usually performed under local anaesthetic. In this procedure a small piece of your temporal artery, located near the temple, is removed and examined under a microscope. 

This test can confirm a diagnosis of temporal arteritis, or giant cell arteritis, or other connective tissue disease, some of which cause blindness or a stroke. Temporal arteritis is a condition in which the arteries that supply blood to the head and brain become inflamed, which can cause symptoms such as severe headaches, jaw pain, and vision changes.

This procedure is usually done under local anaesthesia, meaning you will be awake but the area will be numbed so you don't feel any pain.

You will need a referral letter from your GP or consultant before you make an appointment.

Not all services are covered by health insurance. To find out if you're covered, please check your health insurance before your visit. You can do this on our health insurance cover check page, or by contacting your health insurer. 

If you do not have health insurance or your health plan does not cover the full cost, you will need to pay the balance due before your treatment or procedure. You may be able to claim back some fees on your insurance. To pay an excess not covered by your insurance or any other inpatient fees, please visit our payment page. If you have any queries about paying for your care, please contact the finance team in your hospital.