Referring Provider Frequently Asked Questions

Vascular Lab

To make an appointment or a referral, call

206-215-5921

Fax: 206-215-5922

Monday-Friday
8 am to 5 pm

Download the referral form (PDF)


If the vascular lab finds critical findings on my patient (example, acute lower extremity DVT), what are my options?

Since our vascular lab is co-located within the Vascular Surgery clinic, you have the option of having your patient with critical vascular lab findings receive an in-clinic consultation with a vascular surgeon, along with treatment and follow-up if indicated. The vascular surgeon will work with you in a team-based approach. If surgical or endovascular intervention is not appropriate, the vascular surgeon will refer your patient back to you with a recommended plan for follow-up, which may include an exercise regimen, drug therapy, smoking cessation, lipid management and anticoagulation management.

What are typical indications or reasons for referring patients to the vascular lab?

If you suspect your patient has any kind of circulation problems, the vascular lab will usually offer a test that can identify and quantify the problem or rule-out a possible issue. Some typical indications or reasons for the major exams offered by our vascular lab:

Cerebrovascular evaluation indications and applications
  • Cervical bruits
  • Focal cerebral or ocular transient ischemic attacks
  • Subclavian steal syndrome
  • Blunt neck trauma
  • Amaurosis fugax
  • Re-evaluation of existing carotid stenosis
  • Evaluation of pulsatile neck mass
  • Preoperative evaluation of patients scheduled for major cardiovascular surgical procedures
  • Follow-up after a carotid endarterectomy
  • Evaluation of nonhemispheric or unexplained neurologic symptoms
  • Retinal artery emboli
  • Evaluation of suspected dissection

Peripheral venous evaluation indications and applications
  • Suspected deep venous thrombosis (DVT) of lower or upper extremities 
  • Unexplained leg swelling after major surgery
  • Question of valvular function 
  • Chronic leg swelling of uncertain cause 
  • Suspected or proven pulmonary embolus
  • Follow-up evaluation of anticoagulant therapy to document status of DVT and valve function 
  • Superficial Vein mapping of the  upper and lower extremities for potential use 
  • Dialysis graft/fistula evaluation 

Peripheral arterial evaluation indications and applications 

  • Absent peripheral pulses 
  • Leg pain of questionable etiology, intermittent claudication
  • Rest pain (diabetic neuropathy or ischemia?)
  • Prediction of healing potential for foot ulcers, determination of amputation level
  • Question of aneurysm / pseudoaneurysm
  • Follow-up to vascular surgery and of medically managed vascular disease
  • Arterial trauma
  • Digital cyanosis / Raynaud’s syndrome 
  • Thoracic outlet / compression syndromes

Abdominal vascular evaluation indications and applications

Aorta / Iliac system

  • Aneurysm evaluation
  • Stenosis evaluation 
  • Graft follow-up  

Renal arteries / veins

  • Screening for renal vascular hypertension 
  • Screening for ischemic nephropathy 
  • Monitoring of known renal artery stenosis or renal bypass graft  

Mesenteric vessels

  • Suspected visceral ischemia
  • Aneurysm / pseudoaneurysm  

Portal system

  • Suspected portal hypertension, portal vein thrombosis
  • Shunt evaluation
  • Preoperative vessel patency

Inferior vena cava / Iliac venous system 

  • Suspected thrombosis
  • Suspected extrinsic compression 

Overall, what kinds of exams does the lab perform? 

The vascular laboratory performs a wide variety of vascular diagnostic testing, within four major categories below. We also specialize in dialysis/fistula access evaluation and varicose vein evaluation and treatment.

Categories:

Peripheral venous duplex

Performed by experienced vascular sonographers, we evaluate upper and lower extremities to rule out acute, chronic or recurring deep vein thrombosis (DVT), examine varicose veins and map veins prior to surgery. With all peripheral venous testing, referring physicians will be notified immediately by phone of positive or negative DVT results. If requested by the referring provider, the patient may then receive a consultation with a vascular surgeon, treatment and follow-up monitoring in our clinic.

Peripheral arterial duplex

This test is used to evaluate for occlusive disease, aneurysm, claudication, ulceration, diminished pulses and bypass graft evaluation. For claudicating patients, exercise testing is administered with resting and post-exercise ankle and arm blood pressures prior to imaging of the arteries. Dialysis access grafts can also be assessed for patency and function.

Cerbrovascular duplex

This test is needed to evaluate bruit, transient ischemic attack (TIA), stroke/CVA, preoperative screening and syncope, among other indications. All major branches of the aortic arch are imaged, including innominate, vertebral and subclavian arteries in addition to common, internal and external carotid arteries. If indicated, intracranial arteries are imaged to assess for intracranial artery stenosis and the presence of any collateralization resulting from a significant cervical carotid artery stenosis.

Abdominal duplex

This test is used to monitor aneurysms, occlusive disease and to assess endo-luminal or bypass grafts of the aorta or iliac arteries. Visceral vascular and renal artery duplex are available for patients with hypertension, intestinal angina or intrahepatic stents, such as TIPS. With all abdominal imaging patients, we request at least eight hours of fasting prior to exam time to minimize bowel gas.