Upper Extremity Venous Anatomy and Evaluation

What are radial veins?

Paired vessels that originate from dorsal metacarpal veins and terminate at antecubital fossa

What are ulnar veins?

Paired vessels that originate from palmar arch and terminate at antecubital fossa

What are brachial vein(s)?

Vessel(s) that joins basilic vein to become axillary vein

What is the axillary vein?

Continuation of brachial vein(s) that joins cephalic vein to become subclavian vein

What is the subclavian vein?

Vessel formed by axillary and cephalic junction that joins IJV to become innominate or brachiocephalic vein

What is the internal jugular vein (IJV)?

Vessel formed by confluence of venous sinuses in brain that joins subclavian vein to become innominate or brachiocephalic vein

What is the brachiocephalic or innominate vein?

Vessel formed by confluence of subclavian vein and IJV

What is the SVC?

Vessel formed by confluence of right and left brachiocephalic or innominate veins

What is the basilic vein?

Superficial vessel in forearm and deep vessel in proximal arm that originates at dorsal venous arch and courses along medial arm to join brachial vein

What is the cephalic vein?

Superficial vessel that originates at dorsal venous arch and courses along lateral arm to join axillary vein

What is the antecubital vein or medial cubital vein?

Superficial vessel that connects cephalic and basilic veins in antecubital fossa

Identify this image.

1. Right pulmonary artery

2. Left pulmonary artery

3. SVC

4. Aortic arch

5. Right innominate or brachiocephalic artery

6. Right subclavian vein

7. Right IJV

8. Left IJV

9. Left subclavian vein

10. Left innominate or brachiocephalic artery

11. Innominate or brachiocephalic artery

12. Right subclavian artery

13. Right CCA

14. Left CCA

15. Left subclavian

Identify this image.

1. Radial veins

2. Ulnar veins

3. Brachial vein

4. Axillary vein

5. Subclavian vein

6. Brachiocephalic or innominate vein

7. IJV

8. Basilic vein

9. Superficial basilic vein becomes deep basilic vein

10. Antecubital vein

11. Cephalic vein

Identify this image.

1. IJV

2. Subclavian vein

3. Brachiocephalic or innominate vein

Identify this image.

1. Brachial vein paired with brachial artery

2. Cephalic vein

3. Basilic vein

How is an upper extremity venous exam performed?

1. Evaluate IJV and subclavian veins in supine

2. Ask patient to sniff to visualize IJV and subclavian compressibility

3. Evaluate remainder of upper veins with head of bed elevated

What is the normal sonographic appearance of an upper extremity venous exam?

1. Veins of shoulder and upper arms demonstrate spontaneous and phasic flow WITH cardiac pulsatility

2. Forearm veins DO NOT demonstrate spontaneous flow

3. Superficial veins DO NOT demonstrate spontaneous flow