Upper-Extremity Venous Duplex Evaluation

Abstract

As many as 80% of upper-extremity venous thrombosis cases develop in response to an easily identified problem, such as central venous catheter. The remaining 20% of obstructions are caused by other central venous obstruction, trauma, or Paget-Schroetter syndrome. Appropriate clinical indications for upper-extremity venous duplex evaluation include (but are not limited to) unilateral upper-extremity swelling in the presence of indwelling central venous catheter, upper-extremity erythema and tenderness, superficial palpable cord, or facial swelling. Physical examination and thorough patient history compliment the duplex findings to arrive at an accurate diagnosis. The most effective way to determine the presence or absence of thrombosis is with vein wall compressions. However, most of the upper-extremity central vein segments are located beneath bony structures, which prevent extrinsic compression with transducer pressure. Therefore, the spectral Doppler waveform analysis component of the duplex exam becomes crucial in determining venous obstruction. Common technical components and pitfalls include appropriate color and spectral Doppler settings to reliably demonstrate presence/absence of flow or accurate accounting for innominate vein and supraclavicular/infraclavicular subclavian vein versus occluded native anatomy and large patent branches. When properly executed, the aforementioned components comprise a thorough duplex evaluation of the upper extremity venous system.