Upper Extremity Venous Doppler

Upper extremity venous anatomy

Upper extremity venous doppler is performed  to rule out deep vein thrombosis (DVT). In order for an upper extremity venous thrombus to be considered a DVT the clot has to seen within the internal jugular (IJV), subclavian, axillary or brachial veins. One of the main concerns with DVT is that it can lead to Pulmonary Embolism, that’s when a piece of the clot is dislodged and travels to the pulmonary vasculature (embolus) which can be a life threatening event.

DVT’s are usually caused by stasis, immobility and hypercoagulable states, (Virchow’s triad).

Upper extremity clots are commonly caused by venous lines, especially PICC lines (peripherally inserted central catheter).  The basilic vein is the typical location for insertion of PICC lines, thrombosis can be seen in up to 70-80% according to some studies, especially the longer the line is in place.

Protocol

A typical scanning protocol includes transverse and sagittal images with and without color doppler and spectral wave analysis of the IJV, subclavian, axillary, brachial, basilic, cephalic, radial and ulnar veins. In my institution we include innominate and superior vena cava (SVC) in the vessels we interrogate.

Scan the internal jugular vein in grey scale, compression, color doppler and spectral doppler

Scan the subclavian vein in grey scale, color doppler and spectral doppler

Scan the axillary vein in grey scale, compression, color doppler and spectral doppler

Scan the basilic vein in grey scale, compression, color doppler and spectral doppler

Scan the cephalic vein in grey scale, compression, color doppler and spectral doppler

Scan the brachial veins in grey scale, compression, color doppler and spectral doppler

Scan the radial veins in grey scale, compression, color doppler and spectral doppler

Scan the ulnar veins in grey scale, compression, color doppler and spectral doppler

Pathology

Thrombosis of the right innominate vessel with indwelling catheter

DVT of the subvlavian

Non occlusive thrombosis of the subclavian vein

Duplicate SVC

Thrombus of the right basilic vein

Brachial vein thrombosis

Brachial vein thrombosis

I have had only a handful of thrombosed upper extremity veins in the absence of a line. A couple of those patients were pitchers and had paget schroetter syndrome aka venous thoracic outlet syndrome.
Henry Suarez RDMS,RVT

Further reading:

Paget Schroetter Syndrome

Catheter Related UE Thrombosis

5 thoughts on “Upper Extremity Venous Doppler

    1. I would try scanning above the clavicle and angling down towards the heart. Use a sector probe for the smaller footprint and depth. And also try having the patient propping their head slightly up and towards the side you interested so the muscle is more relaxed..

      Like

  1. As above I am having trouble scanning the subclavian. I tried scanning from on top of the clavicle down – but not great- then under the clavicle – not great – even if you did a video!!!!!!!!!?

    Like

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s