Upper-extremity arterial evaluations

Upper-extremity ischemia is much less common than lower-extremity ischemia. There are diverse etiologies for upper-extremity ischemia, making the diagnosis challenging. A thorough history and physical examination coupled with noninvasive vascular laboratory studies are important in the diagnosis and treatment of these patients. Noninvasive examinations include duplex ultrasound, segmental arm pressures, digital pressures, arterial waveforms using photoplethysmography, and cold challenge testing. These are the tools that can help evaluate arterial stenosis, occlusion, aneurysm, hemodialysis access, Raynaud's syndrome, and arterial thoracic outlet syndrome.