Noninvasive diagnosis of upper extremity vascular disease

The relative rarity of vascular disorders of the arm accounts for unfamiliarity with upper extremity diagnostic testing on the part of even experienced vascular clinicians. Understanding the wide variety of noninvasive tests is imperative if one is to appropriately diagnose and treat these disorders. The diagnosis and localization of arterial occlusive disease is dependent on the use of Doppler-derived arterial pressures, which may be measured serially from the upper arm to the digits. Plethysmographic digital waveforms can be used as an aid in the diagnosis of vasospastic disorders as well as in the assessment of therapy. Similarly, provocative testing with cold stimulation can assist in the diagnosis of Raynaud's and other vasospastic disorders. The use of duplex ultrasonography for venous occlusion, although not as accurate as when used for lower extremity problems, can be a useful aid in the diagnosis of upper extremity venous thrombosis. Symptoms associated with the thoracic outlet syndrome can be evaluated and confirmed noninvasively, measuring Doppler pressures and gauging venous outflow obstruction while the patient performs a variety of positional maneuvers. A thorough knowledge of upper extremity noninvasive tests will provide the clinician with confidence in the objective assessment of upper extremity vascular disease.