Upper Extremity Arterial Duplex

1. 1

   Patient supine, arm extended. Use linear probe (5–12 MHz). Record bilateral brachial blood pressures first.

2. 2

   Subclavian artery: probe at supraclavicular fossa. Sample Doppler — note waveform character (triphasic = normal).

3. 3

   Axillary → brachial artery: follow artery distally with Doppler at regular intervals. Maintain angle ≤60°.

4. 4

   At antecubital fossa, identify brachial bifurcation into radial (lateral) and ulnar (medial) arteries.

5. 5

   Follow radial and ulnar arteries to wrist. Document PSV and waveform at each level.

6. 6

   Note any transition from triphasic to biphasic to monophasic — indicates progressive proximal disease.

7. 7

   Repeat on contralateral arm. A PSV increase of >100% at a focal site = hemodynamically significant stenosis.

• Subclavian artery — Doppler
• Axillary artery — Doppler
• Brachial artery — Doppler
• Radial artery — Doppler
• Ulnar artery — Doppler
• Palmar arch patency

• Waveform character (triphasic/biphasic/monophasic)
• PSV and waveform at each segment
• Pressure gradients
• Plaque or stenosis
• Thrombosis

• Systolic pressure differential >15mmHg between arms = significant asymmetry
• Triphasic → monophasic waveform transition = significant inflow disease
• Thoracic outlet requires dynamic (postural) assessment

Compare bilateral brachial pressures. A >20% PSV elevation at a focal segment indicates hemodynamically significant stenosis.