Current status of noninvasive techniques in the diagnosis of upper extremity disorders. Part I. Evaluation of vascular competency
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Evaluating upper extremity vascular competency requires assessing both anatomy and function. Currently, no single noninvasive test provides comprehensive data, necessitating a combination of methods for accurate vascular assessment.
Area of Science:
- Vascular Surgery
- Diagnostic Imaging
Background:
- Assessing upper extremity vascular competency involves evaluating structural anatomy and functional performance.
- No single noninvasive test currently provides complete information on vascular competency.
Purpose of the Study:
- To review current noninvasive diagnostic methods for upper extremity vascular competency.
- To highlight the limitations and future potential of noninvasive vascular testing.
Main Methods:
- Review of existing noninvasive diagnostic techniques including Doppler, radionuclide scans, isotope clearance, plethysmography, thermography, thermometry, and Allen testing.
- Discussion of the capabilities and limitations of each method in assessing vascular structure and perfusion.
- Consideration of stress testing integration with various modalities.
Main Results:
- Doppler techniques and radionuclide scans offer gross anatomic detail and perfusion data.
- Radionuclide scans provide dynamic and static perfusion data but have limited repeatability due to radiation.
- Isotope clearance techniques offer excellent perfusion data but are difficult to combine with stress testing.
- Segmental arterial pressures, plethysmography, thermography, thermometry, and Allen testing provide good perfusion data and can be combined with stress testing.
Conclusions:
- A comprehensive evaluation of upper extremity vascular competency currently requires multiple noninvasive tests.
- Future advances in high-resolution ultrasound and Doppler flow assessment promise more complete noninvasive evaluation of vascular anatomy and blood flow.
Abstract:
To determine vascular competency in the upper extremity, one must completely evaluate both structural anatomy and the functional performance capabilities of the vascular system. Unfortunately, no single noninvasive test currently available is capable of providing all that information (Table 4-1). Definitive structural anatomy can only be ascertained by surgery or arteriography, although gross anatomic detail can be provided by Doppler techniques and radionuclide scans. Radionuclide scans give good dynamic and static perfusion data and can be coupled with stress testing, but their repeatability is limited by radiation. Isotope clearance techniques are difficult to combine with stress testing, but they do provide excellent information on vascular perfusion. Measurement of segmental arterial pressures, plethysmography, thermography, thermometry, and Allen testing all provide excellent perfusion data and can all be combined with stress testing. The future is bright. Current advances in high-resolution ultrasound real-time imaging combined with quantitative flow by Doppler assessment will provide noninvasive information about structural anatomy and blood-flow characteristics.