Vascular tests

What it is

The workhorse of vascular assessment: a painless scan that combines an ordinary ultrasound picture with a colour map of blood flow, so we can see both the shape of a vessel and how the blood is moving through it — in real time, with no needles and no radiation.

What it feels like

Exactly like the ultrasound used in pregnancy. Warm gel is placed on the skin and a smooth probe is moved over the area. Depending on how much we are mapping it takes anywhere from fifteen minutes to the best part of an hour, and you can usually watch the screen as we go.

What it tells us

Where an artery is narrowed or bigger than normal — as in the neck (carotid & vertebral), abdomen (blood vessels to the vital organs and the main tube — aorta), or the legs (femoral and popliteal arteries). It can also tell us which vein valves are leaking and whether there is a clot (DVT) in the vein. It is the first line of testing in most vascular conditions.

Used for: Varicose veins، Carotid assessment، Arterial aneurysms and blockages

What it is

A simple comparison of the blood pressure at your ankle with the pressure in your arm, using cuffs and a small ultrasound probe. Where the ankle arteries are hardened — often in diabetes — a toe pressure is measured instead, because the smaller toe arteries give a truer reading.

What it feels like

Like having your blood pressure taken a few times over, at the arm and the ankle and sometimes the big toe. The cuffs inflate briefly and let go; it is mildly snug but not painful, and takes about twenty minutes.

What it tells us

Whether the circulation to the legs is reduced, and roughly by how much. A normal ratio is reassuring; a low one points to peripheral artery disease. It is the standard first test when the leg arteries are in question.

Used for: Peripheral artery disease، Diabetic foot

What it is

A companion to the ankle–brachial index. Cuffs placed at several levels of the leg record the pulse of blood arriving at each one, which helps pin down not just whether the circulation is reduced but where the narrowing sits.

What it feels like

The same as the ankle–brachial test — a series of gentle cuff inflations at the thigh, calf and ankle while you lie still. Painless, around twenty to thirty minutes.

What it tells us

The level of a blockage — high in the thigh, at the knee, or lower down — which helps plan whether and how to restore the flow. Often done in the same visit as the ankle pressures.

Used for: Peripheral artery disease

What it is

Where the arteries look borderline at rest, a supervised walk on a treadmill can reveal a narrowing that only shows itself when the leg muscles demand more blood. Ankle pressures are measured before and after.

What it feels like

A gentle, supervised walk on a treadmill until the cramping (claudication) comes on, then a short rest while the pressures are measured again.

What it tells us

How far you can walk before symptoms start, and how much the circulation drops with effort — useful for confirming claudication and for tracking it over time.

Used for: Peripheral artery disease

What it is

A CT scan timed to a small injection of contrast dye, which lights up the arteries so they can be rebuilt as a detailed three-dimensional map. It is quick and shows a great deal.

What it feels like

You lie on a table that slides through a ring-shaped scanner for a few minutes. The dye, given through a small IV cannula in the arm, often brings a brief warm flush and a metallic taste that passes within seconds.

What it tells us

The exact size and shape of an aneurysm, or precisely where and how long an arterial narrowing is — the detail needed to plan a stent or an operation. Because it uses X-rays and iodine-based contrast, kidney function is usually checked beforehand.

Used for: Arterial aneurysms، Peripheral artery disease

What it is

A magnetic-resonance scan of the arteries, using magnetic fields rather than X-rays. It gives a similar map to CT and is often chosen when we want to avoid radiation, or when iodine-based contrast is best avoided.

What it feels like

You lie inside a tunnel-shaped scanner for longer than a CT — often twenty to forty minutes — and it is noisy, so you are given ear protection. It is painless, but less comfortable if you strongly dislike enclosed spaces. A different contrast agent (gadolinium) is sometimes used.

What it tells us

Much the same as CT angiography — the layout of narrowings, blockages and aneurysms — without X-ray radiation. The choice between CT and MR depends on what we need to see and on your individual circumstances. It should be avoided in patients with poor kidney function for risk of Nephrogenic Systemic Fibrosis (a skin condition).

Used for: Peripheral artery disease، Arterial aneurysms

What it is

The most detailed arterial picture of all, taken from the inside: a fine tube (catheter) is guided into an artery through a small puncture, usually at the groin or wrist, and contrast is injected while live X-ray images are taken. It is more involved than the scans above and is often done at the same sitting as a treatment such as angioplasty.

What it feels like

Done under local anaesthetic, with light sedation if you prefer. You feel a small pinch at the puncture and sometimes a warm flush as the dye goes in, but the catheter itself is not felt. Afterwards you rest for a few hours so the puncture site seals.

What it tells us

A precise, moving picture of blood flow that can guide treatment in the same procedure. Because it is invasive, it is generally kept for when a treatment is likely, or when the non-invasive scans leave a question unanswered.

Used for: Peripheral artery disease

What it is

A duplex ultrasound focused on the veins. For varicose veins it traces which valves are leaking and for how long, as well as the size of the vein — both needed to make a decision on the treatment options.

What it feels like

The same painless gel-and-probe scan as any ultrasound, usually done standing for the vein-reflux part so the veins fill naturally. It usually requires you to be exposed from the hips to the toes (with the private parts appropriately covered). Duration of the test is twenty to forty minutes.

What it tells us

For varicose veins, exactly which veins are the problem — the picture that decides which treatment suits you. For surgery planning, whether you have a suitable vein and where it runs.

Used for: Varicose veins، Peripheral artery disease

What it is

A specialised scan of the lymphatic system. A tiny amount of a harmless tracer is injected between the toes (or fingers) and a scanner follows how it drains, showing whether the lymph channels are working normally.

What it feels like

A small injection into the web of the toes, which stings briefly, then a series of scans over a couple of hours as the tracer moves through the system. Mostly a matter of waiting.

What it tells us

Whether swelling is due to lymphedema (a drainage problem) rather than something else — the distinction that separates lymphedema from lipedema and guides treatment.

Used for: Lipedema

What it is

Ordinary blood tests round out the picture: a D-dimer can help weigh up a suspected clot, while cholesterol, blood sugar and kidney function guide risk-factor treatment and the safe use of contrast scans.

What it feels like

A standard blood draw from the arm.

What it tells us

A raised D-dimer alongside symptoms increases the suspicion of a clot and usually prompts an ultrasound; a normal one, in the right situation, helps rule it out. The other tests shape the long-term protection of your arteries.

Used for: Peripheral artery disease