Vascular Disease Detection and Diagnosis
During a full physical exam, the doctor presses and taps the abdomen to feel the shape of internal organs. An odd pulsation emanating from the aorta signals the possibility of an aortic aneurysm. The patient most likely did not experience any symptoms.
Randall B. Griepp, MD, Professor of Cardiothoracic Surgery, explains. "Most aneurysms are asymptomatic — the first symptom comes when the aneurysm ruptures. The majority of aneurysms nowadays are picked up by imaging studies done for other reasons."
"A patient may get an ultrasound to look for a kidney stone or MRI to find the source of back pain, and sitting right there in the picture is an aneurysm," says Michael L. Marin, MD, Professor and Chair of the Department of Surgery.
Although there are very good screening methods available to detect aneurysms, they are not routinely performed. Dr. Marin recommends that patients ask their doctors to screen for them. He also stresses that internists, cardiologists, and general practitioners should think about vascular disease in all their patients, not just those who fall into a high-risk category. Dr. Marin lobbied successfully to have Medicare and other programs cover the cost of such screening.
Diagnostic Technologies for Vascular Disease
Mount Sinai Heart is at the forefront of creating noninvasive imaging techniques for the safe diagnosis of vascular disease. Robert A. Lookstein, MD, Associate Professor of Radiology and Surgery Chief, Division of Interventional Radiology, says, "Before these advances, diagnosis involved invasive tests or even surgery. With the advent of CT and MR angiography, patients can be diagnosed in an outpatient setting."
Newer imaging technologies include:
- Doppler ultrasonography. Measures blood flow, vessel diameter, and clot location and size with sound waves.
- Transesophageal echocardiography. Provides a view of blood vessels from the vantage point of the esophagus. The test is especially useful for imaging the aorta.
- Computed tomography angiography (CTA). Provides a view of blood vessels to determine the size of an aneurysm and the presence of dissections and blockages.
- Contrast-enhanced magnetic resonance (MR) angiography. Uses no ionizing radiation to create images.
- Angiography. Uses a contrast material that shows up on X-ray images to visualize the outline of vessels
Digital Tests Provide Rapid Results
Mount Sinai Heart's Vascular Diagnostic Laboratory houses the most innovative equipment available. Totally digitized, the lab allows for the immediate transfer of images so physicians can review them and make decisions as soon as tests are completed. Vascular ultrasound is an important tool in the diagnosis of both aneurysms and narrowed blood vessels.
The Vascular Diagnostic Laboratory uses the latest ultra-high-frequency ultrasound technology to examine arteries and veins noninvasively and without any radiation. The lab is the first in the United States to offer the latest volume navigation (VNAV) technology, which merges computed tomography (CT) or cardiovascular magnetic resonance (CMR) images with ultrasound to create detailed images of blood flow within vessels.
For patients with suspected peripheral arterial disease, we also perform resting and exercise pulse-volume recordings with segmental pressures and ankle-brachial index — proven tests with excellent diagnostic capability.
Our vascular diagnostic lab is fully accredited by the Intersocietal Commission on the Accreditation of Vascular Laboratories to perform extracranial cerebrovascular, peripheral arterial, peripheral venous, and visceral vascular ultrasound technology. We perform same-day assessments, and reports are available within 24 hours.
One-of-a-Kind Vein Disease Center
Our new multidisciplinary Center for Vein Disease is the first academic center of its kind in the New York metropolitan area. The center offers a range of minimally invasive treatments to people with both cosmetic and life-threatening vein conditions.
"This new center complements Mount Sinai Heart's expertise in arterial disease," says Peter L. Faries, MD, Chief of Vascular Surgery and Professor of Surgery. "All minimally invasive treatments for both artery and vein disease are available in one place."
Interdisciplinary Collaboration Saves Time
Computed tomography (CT) angiography supplies physicians with valuable treatment information for patients with peripheral vascular disease. Diagnostic CT angiography is also useful for monitoring patients after endovascular or open-surgical operations. An exam, performed and interpreted by nationally recognized Mount Sinai radiologists, takes 10 to 15 minutes.
Mount Sinai Heart obtains all CT angiography results using state-of-the-art scanners certified by the American College of Radiology and validated by multiple clinical studies in the United States and abroad. Clinicians may review studies on dedicated workstations with advanced three-dimensional analysis software.
Dr. Lookstein, an interventional radiologist, works with the divisions of cardiology and vascular surgery to assist doctors in diagnosing and treating patients with peripheral arterial disease. This collaboration pays off in increased efficiency.
"Using CT and MR angiography, we see about 125 patients every week," he says. "No one in the Northeast comes close to that."