Upper Extremity Venous Anatomy and Duplex Ch 6 and Ch 33

Digital veins drain blood from the ____

fingers

Superficial palmar venous arch collects superficial drainage and continues into the ____ veins

ulnar

Deep palmar venous arch drains deeper structures and continues into the _____ veins

radial

Ulnar veins travel _____(medial/lateral) on the fifth-digit side

medially

Radial veins travel ____(medial/lateral) on the thumb side

laterally

Radial and ulnar trunks continue toward the ____ veins

brachial

The _____ vein may drain into the brachial veins or more proximally form the axillary vein

basilic

The axillary vein becomes the subclavian vein at the upper border of the ______

first rib

Subclavian vein joins the internal jugular vein at the _____ level

clavicular

Subclavian and internal jugular veins join to form the _______ vein

brachiocephalic (innominate)

Right and left brachiocephalic veins join to form the ____

SVC (superior vena cava)

Superficial veins run above the ____.

deep fascia

_______ is the longest vein in the arm

cephalic

____ vein connects the cephalic and basilic veins at the antecubital fossa

Median cubital

The cephalic vein originates from the _____ of the hand

dorsal venous arch

the ______ vein courses along the biceps and deltoid region.

cephalic

the basilic vein arises from the ____ component of the dorsal venous arch.

ulnar

Median antebrachial vein arises from a ____ venous plexus

palmar

Median cubital vein crosses the antecubital fossa _____

obliquely

______ veins provide collateral pathways when central veins are obstructed

neck

An enlarged IJV may be seen with what diagnosis

congestive heart failure (CHF)

the ____ vein may be seen near the confluence of the IJV and subclavian vein

Internal thoracic

what are the common patterns of antecubital fossa variations

M, H, or N shaped and no communication between cephalic and basilic

____ vein drains the head and terminates in the posterior aspect of the brachiocephalic vein

vertebral

Venous valves are bicuspid folds of tunica ______

intima

Upper-extremity veins have ____(more/less) valves than lower-extremity veins

less

______ flow may be visible near the valve sinus

Rouleaux

describe the order of the deep pathway of the upper extremity venous roadmap

radial/ulnar > brachial > axillary > subclavian

list the veins of the superficial pathway of the upper extremity venous roadmap

cephalic, basilic, medial cubital, median antebrachial

describe the central pathway of the upper extremity venous roadmap

IJV + subclavian > brachiocephalic > superior vena cava

During an upper-extremity venous duplex examination, the sonographer identifies two veins accompanying the brachial artery. Which finding best explains this anatomy?

a. Development of collateral veins secondary to central obstruction

b. An abnormal superficial-to-deep venous connection

c. Normal duplication of the brachial veins

d. An anatomical variation involving the cephalic vein

C

Which superficial vein typically connects the cephalic and basilic veins within the antecubital fossa?

a. Median antebrachial vein

b. Median cubital vein

c. Brachial vein

d. Radial vein

B

what are the 3 sides of virchows triad

1. venous stasis

2. hypercoaguability

3. vessel wall injury

in the upper extremities, catheter injury and ______ are major contributors to venous thrombosis formation

thoracic outlet compression

what are the 5 common risk factors of upper extremity venous thrombosis

1. central venous catheter (PICC line) or pacemaker leads

2. surgery or trauma

3. malignancy or chemotherapy

4. hormone therapy, pregnnacy, oral contraceptives

5. immobility or chronic illness

what do the 2 echogenic lines within the lumen represent

PICC line

what are the 5 common indications for upper extremity venous duplex exams

1. unilateral swelling, pain, redness, or warmth of arm or neck

2. dilated collateral veins across chest or shoulder

3. suspected PE with negative LEV duplex

4. follow up for known thrombus

5. pre-procedure mapping

what are the 6 common contraindications or limitations of upper extremity venous duplex exams

1. irremovable casts

2. poor visualization (depth/edema)

3. central veins not easily compressible

4. anatomical limitations (ex: clavical)

5. open wounds prohibiting imaging access

6. poor patient positioning

Cyanosis on a physical exam may be associated with _________ syndrome

superior vena cava syndrome

Flow may ______ during deep exhalation

decrease (or cease)

Distal arm veins may normally lack spontaneous or phasic flow, but will ________.

augment with distal compression

what are the characteristics of acute thrombus

1. anechoic or lightly echogenic

2. dilated, non compressible vein

3. spongy texture (homogenous)

4. poorly attached to the wall or free floating

what are the characteristics of chronic thrombus

1. bright/echogenic

2. contracted vein with wall thickening

3. attached to the vessel wall

4. may have collaterals

5. may have valve damage or fibrotic webbing (heterogenous)

what type of thrombus is this showing

acute

what type of thrombus is this showing

chronic

_______ is caused by repetitive arm motion or thoracic outlet compression

Effort Thrombosis

______ is obstruction of central venous outflow → bilateral arm and facial swelling

SVC Syndrome

Loss of respiratory phasicity suggests _____ obstruction

proximal

No augmentation suggests obstruction _____

distally

Continuous flow suggests proximal obstruction or _____

extrinsic compression

Collateral vein development suggests a _____ process

chronic

what 3 tests are used for UEV correlation

CT, MR, and venogram (non imaging: Caprini Risk Score)

what are the 2 medical treatment options for UEV thrombosis

1. anticoagulation (primary therapy for acute DVT)

2. promote venous drainage (arm elevation or elastic sleeves)

what are the 2 surgical treatment options for UEV thrombosis

1. SVC reconstruction (graft)

2. surgical decompression (for thoracic outlet syndrome)

what are the 3 endovascular treatment options for UEV thrombosis

1. catheter-directed trhombolysis for selected acute DVT

2. mechanical thrombectomy for selected acute DVT

3. percutaneous transluminal angioplasty and stenting (SVC syndrome or axillo-subclavian issues)