Week 12 - UEA Anatomy & Duplex Exam

What differentiates the axillary from the subclavian artery?

• first rib

• muscular border

  • pectoralis minor

  • teres major

When does the brachial artery bifurcate into the radial and ulnar arteries?

at the cubital (antecubital) fossa

What area does the radial artery perfuse?

posterolateral aspect of the forearm

What area does the ulnar artery perfuse?

anteromedial aspect of the forearm

Describe the course of the radial artery

• passes into the flexor muscles of rhe forearm

• becomes more superficial at the wrist & bifurcates

  • superficial branch: anterior to the thumb

    • feeds the superficial palmar arch

  • main deep branch: posterior to the thumb

    • feeds the deep palmar arch

Describe the course of the ulnar artery

• courses deep to the hook of the hamete (carpal bone where the wrist meets the hand)

• terminates into the superficial palmar arch

• gives rise to the interosseous arteries: supply deep forearm structures

  • anterior

  • posterior

• rarely, continues to the wrist as the median artery

The superficial palmar arch is mainly supplied by the ________ artery.

ulnar

The deep palmar arch is mainly supplied by the ________ artery.

radial

Anatomical positioning of the hand

palm forward, back of hand facing towards me

UEA Duplex Indications

• absent peripheral pulses

• abnormal arterial arm pressures

  • BP Difference >20 mmHg

• TOS symptoms

• cold sensitivity

• digital cyanosis

• raynaud’s syndrome

• bruit

• claudication

• rest pain

• extremity ulcer

• gangrene

• trauma to an artery (iatrogenic or incidental)

• arterial aneurysm

• known hx of PAD

• BPG

• preprocedural assessment

• postoperative assessment

• pulsatile mass

• rubor

• palpable thrill

• marked temperature difference between the hands/fingers

Where do arterial ulcers typically occur at in the upper extremity?

at the fingertips

If a patient is experiencing UE claudication, what are the typical associated activities?

• exercise

• typing

• writing

6 P’s of acute limb ischemia

• pain

• pulselessness

• pallor

• paresthesia

• paralysis

• perishingly cold

Abnormal PSV ratio

>/= 2.1 indicates a >50% (hemodynmically significant) stenosis

diagnostic criteria for UEA stenosis

How to calculate the PSV ratio

PSV @ stenosis / PSV pre-stenosis