3 Normal UE Vascular System

label the arteries from the arm down to the hand

subclavian

axillary

brachial

radial/ulna

palmar arches (superficial and deep)

digital arteries of fingers

what is the origin of the right subclavian art? left?

right SCA : brachiocephalic artery bifurc

left SCA : aorta

how does the subclavian artery course?

passess laterally between scalene muscles

when does the SCA terminate? what does it terminate into?

terminates into axillary artery after it crosses the border of the first rib

what is the diameter of the SCA

.6 - 1.1cm

where does the axillary artery begin?

lateral border of 1st rib

how does the axillary artery course?

continuation of SCA towards arm

where does the axillary artery terminate and what does it become

terminates at inferior border of teres major muscle and becomes the brachial artery

what is the diameter of the axillary artery?

.6 - .8cm

how does the brachial artery course?

runs from medial to lateral over inner elbow

where does the brachial artery end?

bifurcates 1-2cm below elbow

brachial artery becomes

ulnar and radial artery

where does the ulnar artery course?

runs deep along MEDIAL side of forearm (pinky)

where does the radial artery course?

runs along LATERAL side of forearm (thumb side)

what is the common interosseus artery? where is it in relation to ulnar and radial art

branch of ulnar art; runs medial to radial and ulnar

what happens if the radial and ulnar arteries are occluded?

interosseus artery can act as a collateral pathway

what supplies the palmar arch superficial?

ulnar

what supplies the palmar arches deep?

radial artery

what are deep veins?

have corresponding arteries

what are the deep veins of UE?

subclavian (neck)

axillary (axilla)

brachial (arm/elbow)

ulnar & radial (forearm)

deep palmar venous arches

what are the superficial veins of UE?

cephalic (arm/forearm)

basilic (arm/forearm)

median cubital (elbow)

superficial palmar venous arches

digital

the cephalic vein courses on which side

radial side

the cephalic vein joins

the subclavian

the median cubital joins

cephalic and basilic in forearm

the basilic vein courses on which side?

ulnar side

the basilic vein courses

medially to join axillary

what are venae commitantes

paired veins

what are examples of venae commitantes?

brachial

ulnar

radial

what are the veins of the antecubital fossa?

cephalic vein

basilic vein

median basilic vein

median cephalic vein

median antebrachial

what are the main causes of upper limb arterial disorders

occlusion of aubclavian access lines

acute obstruction due to embolization from heart or SA aneurysm

atherosclerotic disease (RARE) 5%

what are the most commonly affected sites of arterial disorders

subclavian artery and axillary artery

what is thoracic outlet syndrome

compression of the SCA, SC vein, or brachial plexus between clavicle and first rib in region of neck ; vessels are partially or completed compressed with arm in certain positions

what can thoracic outlet syndrome cause?

intimal damage. thrombus formation, numbness

why do patients with chronic upper limb arterial diseases have few symptoms

arms develop good collateral circulation around diseased segments

what are the common indications for UE arterial duplex

assess patients with documented arterial disease

pre procedure assessment for planning of intervention

post angioplasty / stent placement

post op evaluation of arterial bypass grafts

eval aneurysm, pseudoaneurysm and arterial venous fistula

evaluation of arterial trauma

evaluation of pts with exercise related pain

what transducer is used to scan UE vessels?

5-10 MHz linear transducer

what freq transducer is best for scanning left SCA and brachiocephalic?

2-2.5 MHz

visuals

what are normal extremity arterial waveforms?

at rest : triphasic high resistance

after exercise : low resistance waveform

what are the three phases in triphasic waveform?

sharp systolic peak

short phase of flow reversal due to elastic recoil

short phase of antegrade flow

what is the purpose of duplex UE venous imaging

assess deep and superficial venous system for the presence or absence of pathology; facilitate clinical management decisions

larger proximal veins have what type of flow pattern

spontaneous phasic flow

what is the flow pattern in veins farther from heart

fewer cardiac pulsations ; demonstrate gentile phasicity due to resp variation

what are common indications for UE venous US?

swelling, pain, tenderness, palpable (arm) cord, pre placement of a central line, indwelling catheter

DVT in axillary, subclavian and braciocephalic/innominate veins

why is venous pathology important?

very noticable and clinically important for thrombosis of major draining vessels

contraindications and limitations to UE scanning

obesity, casts/bandages/sutures, trauma or open wounds, severe edema, central venous line/dialysis catheter, clavicle hampers visualization of entire length of subclavian vein

what transducer is used in scanning UE veins?

5-18 MHz

what vessels are documented in UE venous exam

IJV, brachiocephalic veins, subclavian vein, axillary vein, brachial veins, basilic vein, cephalic vein

do you angle correct in UE venous exam?

no unless measuring velocities

what is the sniff technique

good way to check for wall coaptation (joining of two parts) where clavicle obstructs compression

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