Upper Limb Arteries


  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


  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.

Case 1
Case 2
Case 3