Upper Limb Arterial Duplex Ultrasound

AIM OF STUDY

Define arterial circulation in upper limbs (including hands and digits where clinically indicated).

For Arteriovenous Fistula – check patency of fistula including flow and presence of any graft or anastomotic stenosis.

PATIENT PREPARATION

No special preparation required.

Study Technique: Duplex and Doppler studies of upper limb arteries/AVF non-invasively.

STUDY TIME

20-30 minutes

DIAGNOSTIC CRITERIA

For upper limb arteries – as per Cossman et. Al 1989

  1. Velocity shift (i.e. peak systolic velocity in the stenosis divided by peak systolic velocity proximal to stenosis).
  2. If ratio less than 2.0 equals greater than 50% stenosis.
  3. Ratio greater than 2.0 but less than 4.0 equals 50-74% stenosis.
  4. Ratio greater than 4.0 equals 75-99% stenosis.

For AVF – as per Alex Chao Journal of Vascular Technology 2001

  1. B-Mode imaging of graft or anastomotic stenosis is just as important as velocity shift. If peak systolic velocity is greater than 400 cm/second and velocity ratio is greater than 3.0 indicates a greater than 50% stenosis.