Vascular and microvascular services

The Ernest Cooke Vascular and Microvascular service provides ultrasound and optical based measurements of the peripheral vascular and microvascular blood flow.

Our laboratories are situated at The Royal London Hospital and St Bartholomew's Hospital. We provide a range of services which include:

  • Ankle Brachial Pressure Index (ABPI)
  • Arterial Colour Duplex Ultrasound
  • Venous Colour Duplex Ultrasound
  • Nail fold Capillaroscopy
  • Thermography

Vascular Laboratory

Based at the Royal London Hospital the vascular lab is run by a team of qualified vascular scientists. We provide vascular ultrasound services from:

  • The Royal London Hospital
  • St Bartholomew’s Hospital 


The Microvascular Laboratory is run by Professor Arthur Tucker and provides a broad range of non-invasive tests to evaluate circulatory diseases and physiological response. Although there are Standard Unit protocols, these will be selected depending upon your medical history and specific needs, to answer the referral of your Consultants. The laboratory also has an active clinical research programme and has extensive experience in the design and implementation of research trials. These tests are conducted from:

  • St Bartholomew’s Hospital 

Why choose us

Our hospitals produce some of the best clinical outcomes in the UK.

Barts Health Vascular Laboratory consistently provides patients with outstanding care. A recent Friends and Family Test found that 98% of patients were likely/extremely likely to recommend us to their friends and family.

Our services are easily accessible and we consistently meet the national targets set for hospital waiting times.

Our highly trained team of vascular scientists possess a wealth of experience and have been successfully providing their specialised diagnostic services to physicians and surgeons for over 15 years.

For patients

The test has been requested by a hospital doctor to help diagnose your condition and plan your treatment. Staff will explain the procedure to you and try to answer any questions that you may have.

Vascular Laboratory

What type of test will I have?

The test you will have is usually an ultrasound scan in which special attention is paid to the blood vessels. The scan is sometimes called a ‘duplex ultrasound’ or ‘doppler ultrasound scan’. The vessels most commonly examined are the arteries or veins in the neck, arms, legs or abdomen.

Another test uses ultrasound and blood pressure cuffs to measure blood pressure in the arms and legs. You may also be asked to exercise on a treadmill for up to five minutes at a speed you are happy with.

These tests provide detailed images of your arteries and veins and the blood flow, which will assist your doctor in their diagnosis and any treatment plans.

What will happen during the test?

During the ultrasound scan you will either lie or sit on a couch, or stand on a stool. The room will be partially darkened to enable the person performing the scan to see the monitor. You will be asked to partially undress to allow the area of interest to be scanned.

A clear, water-soluble gel is put on the skin and an ultrasound probe is slid over the skin of the area to be examined. The examination normally takes between 20 and 60 minutes and you may be asked to change positions during the scan.

Preparation and risks

There is no preparation for these tests. You can eat and drink as normal though for examinations of the abdomen sometimes fasting may be advised. There are no known risks accompanying the ultrasound examinations performed within the vascular laboratory.

Who will perform the test?

A Clinical Vascular Scientist trained in the use of medical ultrasound will perform your test, though other staff may be present and the test may be checked by another member of staff. The hospital doctor who made the request will explain the results of your test to you when you next see them.

After the test

The test result will be stored on your hospital records. If your test was requested by a doctor within Barts Health NHS Trust, they will be able to access your results electronically. If a doctor from another hospital requested your test, we will post or fax the results to them.


What type of test will I have?

Microvascular Investigations include:

Nail fold Capillaroscopy - A very sensitive, non-invasive microscopy test that visualises the hairpin-shaped capillaries in the nail folds.

Thermography - This test is performed by means of a state-of-the-art infrared camera that sees the natural radiation generated by the human body and translates it into colour scale. The test evaluates patterns of physiological response, which may indicate a range of disease processes. The assessment is uniquely supported with non-invasive measurement of microcirculatory function.

All blood flow examinations are performed in a quiet, draught-free, temperature and humidity controlled laboratory

Preparation and risks

On the day of your appointment:

  1. If you smoke, you should not do so from the previous evening until the examination is complete.
  2. Avoid heavy meals and fatty food – if your appointment is in the morning, have a light breakfast, such as toast or cereal; if it is in the afternoon, you may also have a light lunch.
  3. Avoid drinking tea, coffee, cocoa or cola, and please do not eat chocolate. These all contain caffeine, a stimulant. You can have any other non-alcoholic drinks.
  4. Please bring the containers of any medication/tablets, which you are presently taking with you.
  5. If you wear nail polish please remove it thoroughly. Please do not wear false nails to the appointment.

These factors all affect results so we thank you in advance for your co-operation.

The examination does not involve any painful procedure or any form of irradiation or other potentially harmful methods.

For clinicians

To refer a patient to the Barts Health Vascular and Microvascular Service:

Internal vascular referrals must be completed online via Millennium (CRS) using the examination name “VUS” or examination code “ZU”. External vascular referrals must be submitted using our referral form and either emailed or faxed to us. Our referral form can be acquired by contacting the vascular lab on the details provided.

Please note that arterial and venous duplex requests can only be submitted by the vascular team once they have examined the patient.

Requests for arterial duplexes also need to be submitted with an ABPI reading.

GPs may only request carotid, aorta and ABPI assessments. For other assessments please refer your patients to a vascular consultant for initial assessment and referral to the Vascular Laboratory. Microvascular referrals can currently only be made using our referral form and either emailed or faxed to us. Our referral form can be acquired by contacting the vascular lab on the details provided below. Guidance on referrals is given in the requesting guidelines.

All reports from the service will be made available either on EPR or PACS or faxed directly.

For further information, please contact the vascular lab by email at:  on tel: 020 359 41076 or in the Vascular Lab, 1st Floor, North Tower, The Royal London Hospital, London E1 1BB