UPPER LIMB VENOGRAPHY It is the study of the veins of the upper limb by the introduction of contrast medium. MR venography with true fast imaging with steady-state precession for suspected lower-limb deep vein thrombosis. Conventional venography (CV) still remains the gold standard for the diagnosis of upper extremity deep venous thrombosis/occlusion. In the upper arm, the usually paired brachial veins flank the brachial artery. Subjects and methods. SUMMARY Upper extremity deep vein thrombosis is a rare thrombotic disorder (1–4% of all DVT) which has the potential for considerable morbidity. Subjects and methods. The CT veinography of upper limb constitutes a new technique reserved for this purpose. reproducible imaging technique with high sensitivity and specificity offering a complete upper limb venous mapping before Diagnosis of proximal upper limb segment DVT including brachial, axillary and subclavian veins recorded 12 TP (54.5%), 8 TN (36.4%), 2 FP (9.1%) and no FN cases. A compression technique is used, starting with the internal jugular vein. It joins the subclavian vein posterior to the medial clavicle, where it forms the brachiocephalic or innominate vein. British Journal of Radiology, 2007. Slightly larger upper limb caliber measurements were derived for NC-MRV and CE-MRV compared to US (NC-MRV 5.2±1.8 mm, CE-MRV 4.9±1.6 mm, US 4.5±1.8 mm, both p<0.001). creating an AVF for hemodialysis. UPPER LIMB RADIOLOGY 2. Prospective study was conducted over a period of thirty These signs and symptoms, however, are nonspecific and confirmation of the diagnosis by objective testing is necessary.14 In addition, many cases of upper extremity DVT are asymptomatic, especially when related to catheter placement.4. Upper extremity deep vein thrombosis is a rare thrombotic disorder (1–4% of all DVT) which has the potential for considerable morbidity. 118-1). However, it is an invasive procedure that must be performed in the radiology department. They may join with the basilic vein before forming the axillary vein. Combined magnetic resonance imaging of deep venous thrombosis and pulmonary arteries after a single injection of a blood pool contrast agent. Venous thrombosis was easily diagnosed, and the innominate veins and superior vena cava were more easily visualized using DSA. CO(2) venography had a sensitivity of 97% and a specificity of 85% in the assessment of upper-limb and central vein patency and stenosis, with conventional venography used as the reference standard. Catheter material and diameter have also been found to affect the incidence of thrombus. Earlier studies documented thrombosis in 2% to 12% of patients with central venous catheters.4 In more recent studies, upper extremity DVT has been documented in 50% to 60% of patients with central venous catheters. The risk of thrombosis increases significantly in patients with both cancer and central venous catheters.11, Hypercoagulability (e.g., antithrombin, protein C, and protein S deficiencies; presence of antiphospholipid antibodies) is found to be prevalent in idiopathic upper extremity DVT in which no obvious associated disease or triggering factor is present. Purpose: To determine prospectively the diagnostic performance of CO 2 venography, by using conventional venography with iodinated contrast material as the reference standard, for the preoperative evaluation of upper-limb and central veins before creation of fistulas for hemodialysis access. Sylvie Chillon. FIGURE 118-2 Transverse gray-scale (A) and color Doppler (B) images demonstrating the normal anatomic relationship of the subclavian vein (V) anterior and inferior (INF) to the subclavian artery (A). The left brachiocephalic vein is approximately 6 cm in length, has a more horizontal course, and joins the right brachiocephalic vein to form the superior vena cava. Traditional x-ray venography, once considered the gold standard for imaging of upper extremity DVT, is a highly accurate examination. The aim of this study was to evaluate the performance CT veinography versus veinography in the establishment of venous Less common signs and symptoms include skin discoloration, a sense of coldness in the hand and forearm, tenderness over the affected vein, paresthesia, and numbness. Only gold members can continue reading. Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten. We present a case which demonstrates the limitations in diagnostic accuracy of ultrasonography in the diagnosis of upper extremity deep venous thrombosis. NC-MRV is feasible, with inferior IQ but comparable venous caliber measurements CE-MRV (mean 7.9±4.58 mm … The SUP, superior. It is uncomfortable for the patient and venous catheterization may be technically difficult secondary to arm swelling. Collateral veins can develop over the shoulder and chest wall. 118-2). A curved 5-2 MHz transducer may be required for larger patients to obtain greater depth of penetration and obtain a larger field of view. The axillary vein begins at the inferior border of the teres major muscle and continues through the axilla to the lateral border of the first rib, where it becomes the subclavian vein. Rotator Cuff Surgery; Shoulder prosthesis; Treatment of fractures (forearm) Carpal tunnel; Trigger finger surgery; Lower limbs. READ PAPER. Cited Here; 21. proximal deep venous system (p=0.010), in studying reports and in highlighting certain anatomical variants (p=0.001). European radiology, 2003. This chapter will review the anatomy of the upper extremity veins and thoracic outlet in addition to the prevalence, causes, clinical characteristics, complications, and diagnostic imaging of upper extremity deep venous thrombosis and thoracic outlet syndrome. Color Doppler duplex ultrasonography with compression technique has become the imaging modality of choice for the diagnosis of upper extremity DVT and is highly accurate for making this diagnosis. With the increasing use of central venous catheters, the prevalence of upper extremity DVT has increased (Fig. Traditional x-ray venography, once considered the gold standard for imaging of upper extremity DVT, is a highly accurate examination. 118-3). The two techniques were comparable for the detection of superficial the central chest veins, such as upper-limb swelling, pain, pallor, and/or visible collaterals, underwent a total of 20 examinations by high-resolution breath-holding 3D gadolinium-enhanced MRV. He has published more than 15 papers. All vessels are compressed except where limited by the clavicle. The most powerful independent predictor of upper extremity DVT was the presence of a catheter, with the risk factor increasing sevenfold in these patients.5,6 The position of the catheter tip has been found to correlate with the incidence of upper extremity DVT. CT venography was performed after a 3-minute delay. Unlike venography, the internal jugular and peripheral brachiocephalic veins can be evaluated, despite the presence of thrombus in the more peripheral vessels. The exact prevalence of symptomatic upper extremity DVT in the general population is unknown but is estimated to be approximately 0.2%.2 In patients with deep venous thrombosis, approximately 90% involve the lower extremity and the remaining 10% involve the upper extremity.3, With the increasing use of central venous catheters, the prevalence of upper extremity DVT has increased (Fig. Alternatively, many centers now forego TOF and go directlyto a 3D contrast-enhanced approach. The incidence of upper extremity DVT is far more common than previously thought, especially with the increased use of central venous catheters and placement of cardiac pacemakers, and in patients with cancer and hypercoagulable states. A pair of valves is present in its caudal end near the confluence. Other less common complications of upper extremity DVT include post-thrombotic venous insufficiency, loss of vascular access, superior vena cava syndrome, septic thrombophlebitis and, rarely, venous gangrene. Collateral veins can develop over the shoulder and chest wall. A short summary of this paper. Eur J Radiol 2011; 80:50–53. He also works in Radiology department of the Military Hospital of Tunis where he has conducted research in vascular imaging in cooperation with vascular surgeons, resuscitator about the contribution of multidetector CT in the dysfunction of hemodialysis arteriovenous fistulas. In patients with idiopathic upper extremity DVT, 42% to 56% of patients have been found to have clotting abnormalities in recent studies. See articles for more information. Upper limb radiography is the radiological investigation of the shoulder girdle, humerus, ulna, radius, carpals and metacarpals of the hand. FIGURE 118-3 Transverse (A) and longitudinal (B) images show thrombus (arrowhead ) around central venous line (arrow ) in the internal jugular (IJ) vein. Additional predisposing factors for upper extremity DVT include venous stasis, trauma, surgery, sepsis, and thoracic outlet obstruction secondary to anatomic anomalies. The aim of this study was to assess the role of CT venography (CTV) in diagnosis of upper limb deep venous thrombosis (DVT) after arterio-venous fistula (AVF) creation for patients with chronic renal failure (CRF) under regular hemodialysis. In the neck, the internal jugular vein courses from the jugular foramen at the base of the skull lateral to the carotid arteries within the carotid sheath. Upper-extremity venography: CO2 versus iodinated contrast material. There was a statistically significant difference between the sensitivities of the two techniques in detecting distal (p<10-3) and Jean-pierre Laissy. Upper extremity deep venous thrombosis (DVT) was historically considered an uncommon, benign, and self-limited condition.1 As such, thrombi involving the upper extremities were thought to be of little clinical significance and often undertreated because the risk of propagation was also believed to be low. However, owing to its invasive nature, risk and complication profile, as well as operational costs, CV is not well suited to be a screening … 37 Full PDFs related to this paper. Hanasch A, Betge S, Poehlmann G, et al. Upper extremity deep venous thrombosis (DVT) was historically considered an uncommon, benign, and self-limited condition. Follow-up examinations performed in four patients within a month were not … Head & Neck. Compression is always performed in the transverse plane because compression in the longitudinal plane may result in sliding off the vessel, potentially causing a false-negative result. Upper limb radiology 1. Arterial interrogation may be performed to assess for suspected limb ischemia, arterial stenosis, or patency of a hemodialysis arteriovenous fistula or graft. The right brachiocephalic vein is approximately 2.5 cm in length and courses in a caudal direction. INTRODUCTION • The study of anatomy using radiographic films is called radiological anatomy. Clinically, the most common presentation of upper extremity DVT is upper extremity and face swelling and pain. Diffuse venous malformations of the upper limb: morphologic characterization by MRI and venography Claudon, Michel; Upton, Joseph; Burrows, P. E. 2001-07-01 00:00:00 Objectives. were first compared for their quality. The reported sensitivity of color Doppler sonography for the diagnosis of upper extremity DVT has ranged from 78% to 100%, with a specificity of 82% to 100%.17,18 False-positive examination results are thought to be rare. Once thought to be uncommon, PE is now reported to have a prevalence of 7% to 36% in patients with upper extremity DVT. Objectives. with chronic renal failure at the stage of dialysis explored by upper limbs veinography and CT veinography. Cantwell CP, Cradock A, Bruzzi J, et al. CT veinography was less irradiating with a reduction in the contrast medium injected dose by 83% compared to veinography. this exhibit are to detail the technical realization of CT venography of upper limb to obtain a venous mapping and list the main venous variant in upper limb and their implication for possible AVF. The study included 57 patients MR venography Zeitschrift: European Radiology > Ausgabe 2/2003 Autor: Stefan G. Ruehm » Jetzt Zugang zum Volltext erhalten. The subclavian vein continues medially, deep to the clavicle, until it joins the internal jugular vein, forming the brachiocephalic vein. The lower limbs are more affected by DVT than upper limbs. The technique involves high volumes of contrast material, no tourniquets, a relatively vertical, non-weight-bearing position, and passive elevation of the legs. The neck is turned slightly away from the side to be examined. Simplified illustration of the major superficial veins of the upper limb. Patients and methods. the upper limb. The subclavian vein is anterior and inferior to the subclavian artery (Fig. Jetzt einloggen Kostenlos registrieren ★ PREMIUM-INHALT. Clinically, the most common presentation of upper extremity DVT is upper extremity and face swelling and pain. These signs and symptoms, however, are nonspecific and confirmation of the diagnosis by objective testing is necessary. Patients with chronic kidney disease with a history of catheterization of the vein, jugular or subclavian, and who had established fistulas or synthetic vascular grafts were targeted. To define the morphologic abnormalities in patients presenting with diffuse pure venous malformations (VM) of the upper extremity. Thereafter, we compared their sensibilities and specificities in detecting various venous However, catheter angiography continues to … The Pulmonary Angiography- Indirect CT Venography Cooperative Group. 2006;17:1763-1769. The superficial basilic and cephalic veins are also usually included in the examination (Fig. Not surprisingly, patients with cancer were found to have the worst prognosis. Valves may be seen in the subclavian vein near this confluence. mapping of the upper limbs before creating AVF for hemodialysis. Upper extremity DVT is also seen to be associated with significant complications, including pulmonary embolism, superior vena cava syndrome, postthrombotic venous insufficiency, and loss of venous access. 118-3). Secondary upper extremity DVT is found in patients with known inciting causes such as central venous catheters, pacemakers, and malignancy. Patients with chronic renal failure at the stage of dialysis require access to a blood through arteriovenous fistula (AVF) at Once thought to be uncommon, PE is now reported to have a prevalence of 7% to 36% in patients with upper extremity DVT.2,13,14 Clinically, the prevalence of symptomatic PE at presentation has been reported to be fourfold less common in patients with upper extremity DVT when compared with patients with lower extremity DVT. However, after 3-month follow-up, the incidence of major or fatal bleeding, recurrent DVT, recurrent PE, or fatal PE was the same. University School of Medicine of Tunis, Tunisia. The parameters for helical CT venography were a 7.5-mm collimation, 7.5-mm reconstruction, table speed of 30 mm/rotation, and pitch of 1.5. C, Longitudinal image shows echogenic thrombus (arrowhead) around peripherally inserted central catheter line (arrow) in the basilic vein (VN). A retrospective review of MRI and venography was performed on five patients, aged 6 months to 20 years, with extensive VM of the upper limbs. Interestingly, conventional risk factors associated with lower extremity DVT, including obesity, advanced age, and surgery were not significant risk factors for patients with non–catheter-related upper extremity DVT.3 Patients with upper extremity DVT were found to be more often male, younger, leaner, and more likely to smoke than those with lower extremity DVT. Kouki S completed his PhD from Medicine Faculty of Monastir, Tunisia. It is a reliable and long time as the technical reference. Real-time grayscale and color Doppler US is used to evaluate both the arterial and venous systems of the upper extremity. The reported sensitivity of color Doppler sonography for the diagnosis of upper extremity DVT has ranged from 78% to 100%, with a specificity of 82% to 100%. Cancer is a significant risk factor for upper extremity DVT secondary to alterations in coagulability factors, low-grade disseminated intravascular coagulation, and stasis secondary to tumor compression. The lowest rates have been for polyurethane and silicone catheters and for those with an external diameter less than 2.8 mm.7,8 In the pediatric population, two thirds of DVT cases occur in the upper extremity, in contrast to adults, and are usually secondary to catheter placement.6. Color Doppler duplex ultrasonography with compression technique has become the imaging modality of choice for the diagnosis of upper extremity DVT and is highly accurate for making this diagnosis.15 Sonography has the advantage of being noninvasive, requiring no venipuncture, ionizing radiation, or contrast agent. Maxillofacial surgery; Spine. Catheter arteriography of the upper extremity has become an infrequent procedure . Two-dimensional (2D) time-of-flight (TOF) MR angiography is awidely used, noninvasive technique for evaluation of the venoussys-5-14However, due to saturation and flow effects, which may result innondiagnostic studies, three-dimensional (3D) gadolinium-enhancedgradient-recalled echo (GRE) imaging may be used for problemsolving. Limitations of duplex sonography include inability to visualize the superior vena cava and more central portions of the brachiocephalic veins. Knowing these relationships will aid in identification of these vessels and help in distinguishing possible large collaterals from the native vessels. Hypercoagulability (e.g., antithrombin, protein C, and protein S deficiencies; presence of antiphospholipid antibodies) is found to be prevalent in idiopathic upper extremity DVT in which no obvious associated disease or triggering factor is present. Malfunction of a central venous catheter may also be an indication of thrombosis. A tender cord may be palpable, especially in the axillary region. Both techniques Alikhan Raza. He is an Associate Professor of Radiology at University School of Medicine of Tunis, Tunisia. Recent immobility and prior venous thromboembolism also play less of role in patients with upper extremity DVT; however, cancer was more common.13, The most serious complication of upper extremity deep venous thrombosis is pulmonary embolism (PE). Spine Imaging; Spinal manipulation; Spine surgery; Upper limbs. Familiarity with normal vascular anatomy, the common pathologic entities that affect the upper extremity, and pitfalls of magnetic resonance (MR) angiography of the upper extremity is important to ensure opti… Cancer is a significant risk factor for upper extremity DVT secondary to alterations in coagulability factors, low-grade disseminated intravascular coagulation, and stasis secondary to tumor compression.9 Bilateral upper extremity DVT was found to be more common in patients with malignancy. Upper limb vein anatomy before hemodialysis fistula creation: cross-sectional anatomy using MR venography. The relevant venous anatomy of the upper extremities and thoracic inlet includes the deep venous system composed of the internal jugular, brachiocephalic (or innominate), subclavian, axillary, and paired brachial veins. Das M, Mühlenbruch G, Mahnken … Image Postprocessing in Cardiac Computed Tomography, Inferior Vena Cava and Its Main Tributaries, Methods for Cardiac Magnetic Resonance Imaging, CARDIOVASCULAR IMAGING CARDIOVASCULAR IMAGING. In this descriptive-analytical study, 41 hemodialysis patients who had been referred for 50 upper limb venographies to the radiology department of Imam Reza (AS) were included. In patients with idiopathic upper extremity DVT, 42% to 56% of patients have been found to have clotting abnormalities in recent studies.6,13,14 Transient causes of hypercoagulability such as estrogen use, pregnancy, and ovarian hyperstimulation have also been observed in women with idiopathic upper extremity DVT.11,12, Additional predisposing factors for upper extremity DVT include venous stasis, trauma, surgery, sepsis, and thoracic outlet obstruction secondary to anatomic anomalies. It is uncomfortable for the patient and venous catheterization may be technically difficult secondary to arm swelling. Variations exist in the recommended techniques and protocols for an ultrasound examination of the upper extremity venous system. The upper limbs CT venography is a noninvasive technique which can be easily performed and interpreted. In addition, small nonocclusive thrombus may be missed in the subclavian vein secondary to the inability to compress this vessel because of the overlying clavicle.16 Furthermore, differentiation of a large collateral from the native vein may be difficult in patients with chronic deep venous thrombosis. Moreover, intravenous iodinated contrast administration carries the risk of … Catheters at the junction of the right atrium and the superior vena cava and those in the mid superior vena cava (SVC) have the lowest incidence of associated thrombosis and those with the catheter tip in the brachiocephalic vein have a higher incidence.4 The ideal position for the catheter tip is at the cavoatrial junction. The internal jugular vein collects blood from the skull, brain, face, and neck. Linear 12-5 or 7-4 MHz transducers are used. Earlier studies documented thrombosis in 2% to 12% of patients with central venous catheters. Mortality from PE ranged from 11% to 34%.13. Venography to evaluate the patency of upper-extremity veins was performed with digital subtraction angiography (DSA) and conventional angiography. Lower limb contrast venography: a modified technique for use in thromboprophylaxis clinical trials for the accurate evaluation of deep vein thrombosis . Log In or, Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), on Venous Sonography of the Upper Extremities and Thoracic Outlet. Moreover, intravenous iodinated contrast administration carries the risk of nephrotoxicity and allergic reaction, in addition to predisposing to the development of thrombus. A retrospective review of MRI and venography was performed … The most serious complication of upper extremity deep venous thrombosis is pulmonary embolism (PE). CHAPTER 118 Venous Sonography of the Upper Extremities and Thoracic Outlet, Jonathan D. Kirsch, Ulrike Hamper, Leslie M. Scoutt. Limb venography; Varicose surgery; Peripheral angioplasty; Musculoskeletal system. To define the morphologic abnormalities in patients presenting with diffuse pure venous malformations (VM) of the upper extremity. Download PDF. Multidetector spiral computed tomography (CT) continues to evolve as a state of the art imaging modality and our … Although less common than lower extremity vascular disease, upper extremity disease affects as much as 10% of the population (,1). 3. The deep leg veins were scanned from the inferior vena cava (IVC) confluence (iliac crest) through the popliteal veins (tibial plateau). At our institution, the internal jugular, subclavian, axillary, and brachial veins are imaged, in addition to the superficial basilic and cephalic veins to the level of the antecubital fossa. In detecting distal ( p < 10-3 ) and Jean-pierre Laissy of anatomy using radiographic films is called radiological.! Courses in a caudal direction Hamper, Leslie M. Scoutt symptoms,,! Found in patients presenting with diffuse pure venous malformations ( VM ) of the brachiocephalic veins can evaluated... The risk of nephrotoxicity and allergic reaction, in studying reports and in certain! 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( forearm ) Carpal tunnel ; Trigger finger surgery ; upper limbs found in patients presenting with diffuse venous... Accuracy of ultrasonography in the upper arm, the most common presentation of upper extremity is! This purpose forming the brachiocephalic veins the study of the upper Extremities Thoracic! Usually included in the subclavian vein is approximately 2.5 cm in length and courses in a caudal upper limb venography radiology unlike,! The upper limb by the clavicle, until it joins the internal jugular vein flank the brachial.! Of duplex sonography include inability to visualize the superior vena cava and central!