Noninvasive Diagnosis of Upper Extremity Arterial Disease

The evaluation of upper extremity arterial disease is multifaceted, as the etiology of ischemia is varied and caused by systemic disease as well as local manifestations of atherosclerosis. For chronic upper extremity ischemia conditions, Raynaud’s syndrome is often the initial presenting symptom. Noninvasive arterial testing of the upper extremity includes measurement of digital pressures and segmental arm pressures, combined with arterial waveforms using photoplethysmography or continuous wave Doppler and testing for cold-induced vasospasm. In selected patients, the addition of duplex ultrasound testing is required to diagnose arterial stenosis, embolus, or aneurysm. Noninvasive physiologic testing facilitates the diagnosis of vasospasm when bilateral digit circulation abnormalities are induced by cold stimuli at rest in the setting of normal findings proximal to the wrist. More proximal lesions are diagnosed by abnormalities of segmental pressures or duplex testing. Having a background knowledge of medical conditions resulting in upper extremity ischemia when combined with a focused history and physical, noninvasive arterial testing can diagnose and guide management of the majority of upper extremity ischemia conditions.