NON INVASIVE INVESTIGATION OF UPPER LIMB ARTERIES AND AV FISTULA

Aim of Study:

1. Define arterial circulation in upper limbs (including hands and digits where clinically indicated).
2. 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: ¾ - 1 hour

Diagnostic Criteria:

1. For upper limb arteries – as per Cossman et. Al 1989
   • Velocity shift (i.e. peak systolic velocity in the stenosis divided by
     peak systolic velocity proximal to stenosis).
   • If ratio less than 2.0 equals greater than 50% stenosis.
   • Ratio greater than 2.0 but less than 4.0 equals 50-74% stenosis.
   • Ratio greater than 4.0 equals 75-99% stenosis.
2. For AVF – as per Alex Chao Journal of Vascular Technology 2001
   • 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.

Comment: The following three duplex images are typical examples of upper limb
arterial pathology.

Click here to view the worksheet for AV Fistula Duplex.
Click here to view the worksheet for Arterial Duplex.