Noninvasive Diagnosis of Upper Extremity Arterial Disease



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.


Upper extremity ischemia Raynaud’s syndrome Vasospasm Digital artery Segmental pressures Duplex ultrasound Plethysmography Cold testing Connective tissue disease Embolization 


  1. 1.
    Allen E, Brown G. Raynaud’s disease: a critical review of minimal requisites for diagnosis. Am J Med Sci. 1932;83:187–200.CrossRefGoogle Scholar
  2. 2.
    Hirschl M, Hirschl K, Lenz M, et al. Transition from primary Raynaud’s phenomenon to secondary Raynaud’s phenomenon identified by diagnosis of an associated disease: results of ten years of prospective surveillance. Arthritis Rheum. 2006;54:1974–81.PubMedCrossRefGoogle Scholar
  3. 3.
    Edwards JM. Basic data concerning Raynaud’s syndrome. Ann Vasc Surg. 1994;8:509–13.PubMedCrossRefGoogle Scholar
  4. 4.
    Landry GJ, Edwards JM, McLafferty RB, et al. Long-term outcome of Raynaud’s syndrome in a prospectively analyzed patient cohort. J Vasc Surg. 1996;23:76–85.PubMedCrossRefGoogle Scholar
  5. 5.
    Waller DG, Dathan JR. Raynaud’s syndrome and carpal tunnel syndrome. Postgrad Med. 1985;61:161–9.CrossRefGoogle Scholar
  6. 6.
    McLafferty RB, Edwards JM, Taylor Jr LM, et al. Diagnosis and long-term clinical outcome in patients presenting with hand ischemia. J Vasc Surg. 1995;22:361–9.PubMedCrossRefGoogle Scholar
  7. 7.
    Porter JM, Snider RL, Bardana EJ, et al. The diagnosis and treatment of Raynaud’s phenomenon. Surgery. 1975;77:11–23.PubMedGoogle Scholar
  8. 8.
    Nielsen SL, Lassen NA. Measurement of digital blood pressure after local cooling. J App Phys Resp Environ Exerc Phys. 1977;43:907–10.Google Scholar
  9. 9.
    Lutolf O, Chen D, Zehnder T, Mahler F. Influence of local finger cooling on laser Doppler flux and nailfold capillary blood flow velocity in normal subjects and in patients with Raynaud’s phenomenon. Microvasc Res. 1993;46:374–82.PubMedCrossRefGoogle Scholar
  10. 10.
    Lafferty K, de Trafford JC, Roberts VC, et al. Raynaud’s phenomenon and thermal entrainment: an objective test. BMJ Clin Res. 1983;286:90–2.CrossRefGoogle Scholar
  11. 11.
    Singh S, de Trafford JC, Baskerville PA, et al. Digital artery caliber measurement: a new technique of assessing Raynaud’s phenomenon. Eur J Vasc Surg. 1991;5:199–205.PubMedCrossRefGoogle Scholar
  12. 12.
    Yurdakul M, Tola M, Uslu OS. Color Doppler ultrasonography in occlusive diseases of the brachiocephalic and proximal subclavian arteries. J Ultrasound Med. 2008;27:1065–70.PubMedGoogle Scholar
  13. 13.
    Silva M, Hobson II RW, Pappas PJ, et al. A strategy for increasing use of autogenous hemodialysis access procedures: impact of preoperative noninvasive evaluation. J Vasc Surg. 1998;27:302–8.PubMedCrossRefGoogle Scholar
  14. 14.
    Ferring M, Henderson J, Wilmink A, et al. Vascular ultrasound for the pre-operative evaluation prior to arteriovenous fistula formation for haemodialysis: review of the evidence. Nephrol Dial Transplant. 2008;23:1809–15.PubMedCrossRefGoogle Scholar
  15. 15.
    Wong V, Ward R, Taylor J, et al. Factors associated with early failure of arteriovenous fistulae for haemodialysis access. Eur J Vasc Endovasc Surg. 1996;12:207–13.PubMedCrossRefGoogle Scholar

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© Springer-Verlag London 2013

Authors and Affiliations

  1. 1.Department of Vascular SurgeryOregon Health and Science UniversityPortlandUSA

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