Vascular laboratory for the surgeon

The introduction of a noninvasive vascular laboratory emerged from the need for more accurate differential diagnosis, localization of disease, measurement of severity, and documentation of progression of occlusive arterial disease and efficacy of treatment. Plethysmographic and Doppler techniques have been the cornerstones in the development of noninvasive studies. Our vascular laboratory experience during 1977–1994 includes 36,573 examinations performed on 19,646 patients. Occlusive arterial disease of the lower limb was evaluated by 7408 complete lower limb examinations, of which 4939 included also a treadmill exercise test, 4539 toe pressure measurements, and 10,585 follow-up examinations. Altogether, 9102 miscellaneous examinations included ambulatory ECG and systemic blood pressure monitoring, assessment of limb viability by tcpO2, Laser Doppler flowmetry and skin perfusion pressure measurement, as well as upper extremity studies, among others. Although new techniques were introduced and tested during the years, the routine examinations have remained rather simple. Workup for claudication contains a structured questionnaire, segmental pressures and plethysmographic evaluation, and exercise test on treadmill, whereas diabetes and suspicion of CLI also necessitate toe pressures. Diabetic patients and those evaluated for aortic surgery also undergo ambulatory or stress test ECG monitoring. Carotid patients are noninvasively assessed by Duplex in the Radiological Department. A vascular laboratory managed by the vascular surgeon serves surgical needs well, as the tests can be tailor made to specifically answer relevant clinical questions.