Noninvasive Diagnosis of Upper Extremity Arterial Disease

Abstract

Diagnosis of upper extremity arterial disease is complex as ischemia of the upper extremity may be caused by systemic disease as well as localized manifestations of atherosclerosis. For chronic disorders of upper extremity ischemia, Raynaud’s syndrome is often the initial presenting symptom. Noninvasive testing for upper extremity arterial disease includes digital pressures, segmental arm pressures, arterial waveforms using photoplethysmography and/or continuous wave Doppler, and testing for cold-induced vasospasm as well as evaluation with duplex ultrasound for evidence of arterial stenosis or aneurysm. Noninvasive studies facilitate the diagnosis of vasospasm when bilateral abnormalities of digit circulation are induced by cold or emotional stimuli with normal findings at rest. Systemic disorders of digital circulation are characterized by bilateral abnormalities of digital circulation at rest with normal findings proximal to the wrist. More proximal lesions are diagnosed by abnormalities of segmental pressures or duplex findings suggestive of aneurysm or stenosis. Applied properly, with background knowledge of the conditions resulting in upper extremity ischemia, the combination of the history and physical examination, plain x-rays of the shoulder and neck, blood tests, and noninvasive and possibly invasive examinations of the arteries of the upper extremity arteries can in the large majority cases determine the etiology of upper extremity ischemia and guide treatment.