Imaging tests

Common tests to diagnose and/or treat vascular conditions include:

Duplex ultrasound: This test may also be called a Doppler test or duplex scan. It uses sound waves to capture images of how blood flows through your veins and arteries.

Carotid duplex: This test is also called carotid ultrasound or carotid Doppler. We use ultrasound technology to monitor blood flow through the major arteries in your neck and look for blockages.

Ankle-brachial index (ABI) test with Doppler: This test measures how well blood flows to your limbs. We may use ABI to diagnose peripheral arterial disease. We use a blood pressure cuff and ultrasound images to compare blood pressure in your arm to blood pressure in your ankle. 

Angiogram: This procedure can find blockages in your arteries. We use X-rays and a contrasting dye to show areas where an artery is blocked or damaged. We can also use angiogram to see the blockage during treatment.

Computed Tomography Angiography (CTA) and Magnetic Resonance Angiography (MRA): These advanced imaging tests let us see your blood vessels and organs in 3D. This helps us make a precise diagnosis and develop a plan for treatment.
 

Medication types

Common medications include:

Blood pressure, cholesterol and diabetes medications: There are a variety of drugs to manage hypertension (high blood pressure). Drugs such as statins can help lower your cholesterol. If you have diabetes (high blood sugar), you may take medication called metformin or have insulin injections to manage your blood sugar levels.

Blood thinners: These medications, also called anticoagulants or antiplatelets, can help your blood flow more easily. This will reduce the risk of blood clots. Blood thinners can lower your risk of heart attack, stroke or clots in the lungs (pulmonary embolism). Warfarin is a common anticoagulant. Aspirin is a common antiplatelet.

Catheter-directed thrombolytic therapy: This nonsurgical treatment is for deep vein thrombosis or people at risk of pulmonary embolism (blood clots in the lungs). If blood thinners have not worked to dissolve large clots, your care team can use a catheter to deliver medications called thrombolytics directly to the clot. This can be combined with suction to break up or remove the clot. 
 

Self-management for vascular conditions

The following lifestyle changes can help slow the progress of vascular disease:

Eat healthy: Eat less salt and saturated fat. Healthy eating can lower your risk of plaque buildup (atherosclerosis), a major cause of vascular disease.

Get active: Regular exercise can improve symptoms and help you live longer. Your care team can recommend activities that are safe and fun, whether you prefer walking, swimming, gardening or golf.

Manage stress: When you feel stressed, your blood pressure may rise. Over time, high blood pressure can increase your risk of vascular problems. If you feel stressed, discuss it with your care team. They can help you find ways to relax and be mindful of your stress levels.

Stop smoking and drinking: Drinking alcohol and smoking both make it harder for your circulatory system to work well. Stopping these habits can slow the progress of vascular conditions and help you feel better.

Ablation, phlebectomy and laser treatments

Sclerotherapy: Also called medical ablation, this is the most common treatment for spider and varicose veins. We inject medication into the damaged veins through a catheter (a thin, flexible tube inserted in a blood vessel). It causes the veins to harden so that they no longer fill with blood. Eventually, the unused veins shrink and disappear. Your body absorbs the resulting scar tissue.

Radiofrequency ablation: This type of ablation uses heat energy to seal damaged veins. We use a catheter with a heated tip to cauterize (burn) the walls of the vein, destroying the damaged tissue. Once the vein is no longer able to carry blood, it disappears. Your body absorbs the scar tissue.

VenaSeal: VenaSeal fills damaged veins so that they shrink and disappear. VenaSeal is a newer treatment that uses an adhesive (glue) to seal the veins.

Phlebectomy: In this minimally invasive treatment, a surgeon removes the damaged parts of veins that are near the surface of your skin. It is sometimes used instead of sclerotherapy. We will make a series of small incisions (cuts) with a needle or scalpel and use a tiny hook to remove the damaged vein.

Laser treatment: Laser procedures use heat to treat spider and varicose veins. We will direct laser energy at the damaged part of a vein by inserting a tiny fiber into the vein through a catheter. This causes the vein to close. Your body absorbs the scar tissue.
 

Angioplasty and stent placement

For angioplasty, we use a long, hollow tube (catheter) to create a larger opening in an artery, increasing blood flow. We can use this technique in many parts of the body, including in arteries that carry blood to the kidneys, the legs and the brain. 

The first angioplasty ever performed was done at OHSU in the 1960s. Today, types of angioplasty procedures include:

Balloon angioplasty: Your surgeon inflates a small balloon inside your artery to open the blocked area.

Atherectomy: A tiny surgical device on the end of a catheter is used to shave away any blockages in an artery.  

Laser angioplasty: Heat energy from a laser removes blockages.

Stent placement: Your surgeon inserts a tiny coil inside the blocked artery. The coil expands to open the blocked area and is left in place like a scaffold to keep the artery open.
 

Endovascular aneurysm repair (EVAR) and thoracic endovascular aortic repair (TEVAR)

These treatments for aortic aneurysms avoid abdominal or chest surgery. Instead, your surgeon uses a catheter and small incisions in the groin to reach the weakened artery. We reinforce it using a device called a stent graft (a mesh metal tube wrapped in fabric). The metal stent forms a framework that holds the fabric graft in place.

Fenestrated endovascular aortic aneurysm repair (FEVAR)

This procedure is used when an aortic aneurysm is located too close to the kidneys for EVAR to be an option. It uses a special graft that allows blood to flow through the branches of the renal arteries, which connect to the kidneys.

Transcarotid artery revascularization (TCAR)

This treatment for carotid artery disease can lower your risk of future strokes. It may be used to avoid traditional surgery (carotid endarterectomy). We make a small incision at your neckline to insert a catheter. This temporarily reverses blood flow through the carotid artery, sending it away from your brain. Your blood goes through a filter outside your body to remove plaque. The filtered blood returns to your body through a second catheter in your thigh. We then place a stent to improve blood flow through the carotid artery. Once the stent is in place, we restore normal blood flow.

Endovascular repair of aortoiliac and common iliac artery aneurysms

These minimally invasive techniques use special grafts to reinforce weak sections of the main arteries in your abdomen or pelvis.

Inferior vena cava (ICV) filter placement and removal

If medication does not help or won’t work to treat blood clots, we may use a catheter to insert a filter into the inferior vena cava. This is the large vein that returns oxygen-poor blood from the body to the heart. An ICV filter catches large clots, keeping them from reaching your heart and lungs. The filter can stay in place permanently or be removed later.

Surgical bypass

Bypass surgery can treat peripheral arterial disease. We insert a long, cylinder-like tube called a graft. The graft reroutes blood flow, creating a detour to “bypass” the affected blood vessel. 

Grafts are usually made of synthetic materials, but sometimes we can use a blood vessel from another part of your body.

Depending which blood vessel we need to bypass, this surgery may be done in your leg or your stomach. Leg bypass surgery is also called lower extremity bypass, leg bypass, fem-pop bypass, fem-tib bypass or fem-distal bypass. Bypass surgery in the stomach may be called aortic bypass, aorto-iliac bypass or aorto-femoral bypass.

Endarterectomy

This type of surgery removes plaque buildup inside an artery wall, restoring normal blood flow. It is often done to clear blockages of the main arteries in the neck (carotid endarterectomy) or the large artery in the groin (femoral endarterectomy). It can also clear arteries that connect to the kidneys (renal endarterectomy).

We make an incision and insert a catheter to keep blood flowing during surgery. We then clean out the plaque clogging your artery and close the incision with stitches. 
 

Surgery for thoracic outlet syndrome

If thoracic outlet syndrome doesn’t respond to medication, physical therapy or thrombolytic therapy, your care team may consider surgery. We can use a variety of approaches to repair or remove the blood vessels and muscles causing compression in your chest.

OHSU’s vascular team has deep expertise in surgery to treat arterial, venous and neurogenic thoracic outlet syndrome. We will work with you to develop a treatment plan based on your specific needs.

Hemodialysis access

There are three main ways to place dialysis access:

Arteriovenous (AV) fistula: We join an artery and a vein together. This makes the blood vessels stronger and better able to handle the demands of dialysis. 

An AV fistula is usually placed surgically, often in your arm. OHSU also offers a less invasive technique that uses catheters and radiofrequency (heat) energy to create an AV fistula.

Arteriovenous (AV) graft: We use this method if an AV fistula is difficult to create. It makes the connection between an artery and a vein using synthetic material instead of your own blood vessels.

Venous catheter: In some cases, we may place an external catheter in a large vein in your leg, neck or chest instead of using an AV fistula or graft for access. This is less common for long-term dialysis. 
 

Peritoneal access

Peritoneal dialysis filters your blood while you rest at night by using a small tube to access your abdomen. 

A surgeon places the tube in the wall of your lower abdomen, near your navel. This allows your care team to reach the space between your organs and abdomen wall. This space is called the peritoneal cavity. 

The tube delivers a waste-absorbing solution that fills the peritoneal cavity. The fluid remains long enough to filter waste and toxins, then is removed through the tube.