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Noninvasive Vascular Diagnosis pp 483–497Cite as

Venous Duplex Ultrasound of the Upper Extremities

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Abstract

Upper extremity deep vein thrombosis (UEDVT) accounts for 10% of all DVT cases. Upper extremity DVT may be primary (30%) or secondary (70%). Upper extremity DVT has been inaccurately regarded as a rare and benign disease and is an understudied condition with severe consequences. Most primary cases have associated underlying anatomic anomalies; however 20% of episodes are idiopathic. Indwelling catheters are the most common risk factor for secondary UEDVT. Pulmonary embolism (PE) is the most devastating complication reported in up to 36% of cases. Pulmonary embolism is twice as common with secondary UEDVT than with primary UEDVT. Venous anatomy, including zones of the upper extremity and a venous duplex scanning protocol for the upper extremity, is described. Indications for duplex imaging, thrombus characteristics and locations, and soft tissue abnormalities including abscesses, cysts, aneurysms, and pseudoaneurysms are all presented. Limitations and potential pitfalls are defined for duplex imaging of the upper extremity. Requirements for the Intersocietal Commission for the Accreditation of Vascular Laboratories (ICAVL) certification for upper extremity duplex imaging are presented. A comparison of upper extremity and lower extremity DVT is given. Duplex ultrasonography is the method of choice for the initial diagnosis of patients suspected with thrombosis of the upper extremities. However, in patients with isolated flow abnormalities, contrast venography should be performed. The use of CT scanning and MRV are also discussed. In children, more than 50% of the UEDVT events are due to the presence of central venous lines. Treatment options are briefly reviewed for UEDVT. The concept of venous patency restoration followed by relief of extrinsic compression is the accepted therapeutic approach for the treatment of primary UEDVT. Three different types of thrombi can occur in association with central venous catheters. The catheter adherent fibrin sleeve is the most common. The likelihood of developing catheter-related UEDVT is related to the number of punctures during catheter insertion, the number of catheters inserted, the location of the catheter tip, the duration of catheterization, the type of catheter used, the type of fluid administered, catheter-related infection, hypercoagulable states, and the presence of congestive heart failure. The incidence of UEDVT is increasing perhaps due to the increased use of central lines or due to increased awareness of the disease process. The first step in treatment is to evaluate the need for continued catheter use and to establish vessel patency.

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Acknowledgments

I would like to acknowledge Geri Meister, Angela N. Fellner, Ph.D., and the Good Samaritan Hospital Library staff for their assistance in preparation of this chapter.

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Authors and Affiliations

  1. Department of Vascular Surgery, Good Samaritan Outpatient Center, 6350 Glenway Avenue, Suite 208, Cincinnati, OH, 45211, USA

    Joann M. Lohr M.D., FACS, RVT

  2. Good Samaritan Hospital, Cincinnati, OH, USA

    Joann M. Lohr M.D., FACS, RVT

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Correspondence to Joann M. Lohr M.D., FACS, RVT .

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Editors and Affiliations

  1. Robert C. Byrd Health Sciences Center, Dept. Surgery, West Virginia University, MacCorkle Ave. SE 3100, Charleston, 25304, West Virginia, USA

    Ali F. AbuRahma

  2. , Interventional Cardiology, UC San Diego Sulpizio Cardiovascular Cen, 9300 Campus Point Drive 7784, La Jolla, 92037, California, USA

    Dennis F. Bandyk

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Lohr, J.M. (2013). Venous Duplex Ultrasound of the Upper Extremities. In: AbuRahma, A., Bandyk, D. (eds) Noninvasive Vascular Diagnosis. Springer, London. https://doi.org/10.1007/978-1-4471-4005-4_39

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