Week 10: Upper Extremity Arterial Scanning Flashcards
Upper extremity arterial imaging is ____ common than lower extremity arterial imaging because significant atherosclerotic obstructive disease in the arms is much less common than in the legs
less
- Right common carotid artery: Begins at the ____ and ends at the ____
- ** Left common carotid artery**: Begins at the ____ and ends at the carotid bifurcation
- Innominate artery (AKA: ____): Begins at the aortic arch and ends at the bifurcation into the____ and ____
*Only one innominate artery
- innominate bifurcation, carotid bifurcation
- aortic arch
- brachiocephalic, right common carotid, right subclavian arteries
Identify 1-7
- right subclavian
- thoracic outlet
3.axillary artery
4.brachial artery
5.radial artery
6.ulnar artery
7.antecubital fossa
Anatomy:
Subclavian arteries become the ____ arteries as they pass under the clavicle and over the first rib to exit the thoracic cavity called ____
axillary
thoracic outlet
Anatomy:
Axillary artery: Begins at the thoracic outlet and ends at the insertion of the ____ in the upper arm then becomes ____
teres major muscle
brachial artery
Anatomy:
Brachialartery: Begins at the insertion of the ____ and ends at the bifurcation into the ____ and ____ arteries slightly distal to the level of the ____
teres major muscle
radial, ulnar
antecubital fossa
Normally ____ artery is a dominant artery
radial
For arms, the BP difference > ____mmHg indicates obstruction of the artery
20
Anatomy:
1. Radialartery: Begins just distal to the antecubital fossa and ends at the ____
2. Runs near the radius, staying ____ most of the way through the forearm to the ____ (thumb) side of the wrist
- palmar arches
- superficial, lateral
- ____:Begins just distal to the antecubital fossa and ends at the palmar arches
- Runs ____ towards the ulna and more superficial as it approaches the medial (pinky) side of the wrist
- Ulnar artery
- medially
Anatomy:
1. Entire upper limb
2. Segment from the shoulder to elbow
3. Segment from the elbow to the wrist
- Upper Extremity
- arm
- Forearm
Anatomy: definition
1. Upper Extremity
2. arm
3. Forearm
- Entire upper limb
- Segment from the shoulder to elbow
- Segment from the elbow to the wrist
Upper Extremity Arterial Imaging:
Name the direct imaging
Duplex imaging
-Produces a sonographic image
Upper Extremity Arterial Imaging:
Name the indirect imaging (4)
- CW Doppler
- segmental limb plethysmography
- PVR (pulse voume plethhysmography)
- PPG (photoplethysmography)
*Plethysmography is used to measure changes in volume in different parts of the body. The test may be done to check for blood clots in the arms and legs.
Upper Extremity Arterial Duplex: Indications? (2)
- rule out clot
- assessment of the radial artery
What is the most common reason for UE arterial scanning?
- assessmnt of the radial artery
2.
What is the purpose of the assess the radial artery for? (2)
- for coronary artery bypass conduit
- part of a radial-to-cephalic dialysis fistula *starting as distally as possible
Signs & Symptoms for UE arterial Duplex (5)
- UE pain/discomfort
- arm/hand asymmetry
- discolored fingers
- temperature difference between hands/fingers
- ulcers on the fingertips
TDR
Patient posistion for UE arterial Duplex?
supine or semi-Fowlers position
What test is performed on the each image?
image left: Axillary and brachial arteries - arm abducted and externally rotated or arm up and elbow bent- forming a 90-degree angle
image right: Radial and ulnar arteries: arm extended with the hand in a supinated position (palm up)
Scan Technique
Start in a____ plane starting at the proximal neck -just inferior to the ____
TRV, mandible
Scan Technique
Return to a TRV probe orientation, angle inferiorly at the level of the proximal clavicle (________) to obtain images of the innominate artery
-Probe @ the suprasternal notch -Utilize color and spectral Doppler
suprasternal notch
- RCCA
- RSCA
- INOM
Scan Technique
1. Keeping the probe in a TRV orientation, slide the probe across the clavicle, angling slightly ____, to obtain images of the subclavian artery
2. May need to move the probe inferior to the clavicle and angle ____ for the mid/distal portions
3. Subclavian artery is ____ to the subclavian vein
- inferiorly
- superiorly
- superior
Scan Technique
- At the axillary level, obtain TRV and
SAG images of the axillary artery
- Axillary artery lies ____ to the
axillary vein - Utilize color and spectral Doppler in a SAG plane
lateral
Scan Technique
1. Distal to the axilla, obtainTRV and
SAG images of the brachial artery
2. Runs along the inner aspect of the
arm to the elbow
3. Has ____ paired veins called:____ adjacent to the artery
4. Utilize color and spectral Doppler in a SAG plane
2, brachial veins
Name the vessel 1-2
- brachial veins
- brachial artery
- Moving distally, the brachial artery bifurcates into the ____.
- With the palm supinated, on the lateral side (thumb) obtain TRV and SAG images of the ____
- It runs along the ____ side of the forearm
- It has ____ paired veins called: ____ adjacent to the artery
- Utilize color and spectral Doppler in a SAG plane
- forearm
2.radial artery
3.thumb/lateral - 2, radial veins
Scan Technique
1. Moving distally, the brachial artery bifurcates into the forearm. With the palm supinated, on the medial side obtain TRV and SAG images of the ____
2. It runs along the ____ side of the forearm
3. It has ____ paired veins called:____ adjacent to the artery
4. Utilize color and spectral Doppler in a SAG plane
- ulnar artery
- pinky/medial
- 2, ulnar veins
Name of the vessel?
ulnar artery
Scan Technique
1. Moving distally into the ____ and ____
2. ____ performed for a typical UE arterial duplex exam
3. ____ typically used for a quicker assessment of the arterial signals
- palmar arch, digital arteries
- Rarely
- CW Doppler
Name the vessels from A to F
A: innominate artery
B: subclavian artery
C:Axillary artery
D: Brachial artery
E: Radial artery
F: Ulnar artery
*Note: further you go, higher the resistence
Normal angle corrected PSVs for the UE arteries:
1. Subclavian & axillary: ____ cm/s
2. Brachial: ____cm/s
3. Radial & ulnar: ____ cm/s
-Palmer arches & digits: lower than PSVs above
- Note that > _____mmHg difference is abnormal
- 50-100
- 50-100
- 40-90
- 20
No universally accepted velocity cut off points that determine the severity of a stenosis in the UE arteries.
However, if there is a ________of the PSV across a stenosis compared with the proximal normal segment, this indicates a <____ diameter reduction/stenosis
More severe stenosis will further _____ systolic and diastolic velocities
doubling , 50%, increase
Most common cause of stenosis within the UE arteries is ______
atherosclerotic plaque
Usually atherosclerotic plaque develops in the ____ and occasionally the ____
-Proximal subclavian arteries can be difficult to see due to vessel depth, size, and geometry
-In this situation, diagnosis can be made by indirect signs such as high-velocity jets, turbulence, or post stenotic dampening
proximal subclavian arteries, axillary
arteries
- Acute frequently caused by ____ from the heart
- occur most commonly in ____, ____ & ____ due to the smaller vessels
- The vessel lumen may appear clear on a 2D image, but there will be an ____of flow with color and spectral Doppler
- embolization
- brachial, radial, ulnar
- absence
What is AVM?
atriovenous malformation: an abnormal connection of veins and arteries which distrupts normal blood flow and O2 circulation
AVM
1. is usually ____
2. can be palpable area
3. can have a blueish tint to it on the skin
- congenital
2.
AVM
1. Very well seen with color Doppler as a region of high vascularity
2. Spectral Doppler will demonstrate ____, ____ waveforms within the malformation
low-resistance, high-volume flow
Aneurysms & Pseudoaneurysms
1. Rare
2. Can present as visible pulsatile swelling over the area of concern
3. **Aneurysms **are most seen in the ____ associated with ____
4. Pseudoaneurysms are most seen in the ____, ____, and ____ arteries following arterial puncture for catheter access
- subclavian artery, thoracic outlet syndrome
- radial, brachial,axillary
Aneurysms vs Pseudoaneurysms
aneurysm of subclavian artery
Aneurysms vs Pseudoaneurysms
pseudoaneurysm
What is TOF?
Thoracic Outlet Syndrome - Agroup of disorders that occur when arteries or nerves in the space between the collar bone and first rib (the thoracic outlet) are compressed
TOF
1. Can cause pain in the shoulders and neck and numbness in the fingers
2. Causes: Physical trauma (ex: car accident), pregnancy, anatomical defects (ex: having an
extra rib), repetitive injuries from job or sports related activities
3. More comm on in **females **than males
4. Arteries involved can be evaluated with CW Doppler or Duplex imaging
Duplex Evaluation of TOS
1. Have the patient in a ____ position so that certain provocation maneuvers can be performed
- The subclavian artery is imaged from ____ to ____ with the armatrest
- The subclavian artery is then imaged using any of the provocation maneuvers that were found to reduce or obliterate the radial artery signal (done prior to duplex imaging with CW Doppler pencil probe) For example: (4)
- Any changes in the flow pattern or areas of significant velocity increase along the subclavian artery during provocation maneuvers should be recorded
- sitting
- proximal to distal
- Hyperabduction, Abduction with arm externally rotated, Raise/lower the arm, Rotate head to either side
Normal appearance of UE arteries (3)
- high resistive flow
- triphasic at rest
- changes in external temperature (vasoconstriction/vasodilation)
TOS causes (4)
- trauma
- pregnancy
- anatomical defects
- re,petitive injuries
