Ultrasound examination of upper extremity vessels

When people have a physical examination, the blood vessels in the upper limbs are also often checked. However, many people are not particularly clear about the test results of upper limb vascular examinations. The recovery of human upper limb blood vessels is also very complex, including two important blood vessels: arteries and veins. Therefore, the results of upper limb vascular ultrasound examination also play an important role in people's health. So what diseases does upper limb vascular ultrasound examination mainly detect?

Arteries of the upper limbs

(1) The axillary artery connects with the subclavian artery at the lateral edge of the first rib, passes through the axilla to the inferior edge of the latissimus dorsi muscle and connects with the brachial artery. The branches are mainly distributed to the shoulder muscles, pectoral muscles, latissimus dorsi and breast.

(2) The brachial artery runs along the medial groove of the biceps brachii and accompanies the median nerve. At the antecubital fossa, it divides into the radial artery and the ulnar artery.

(3) The radial artery descends parallel to the radius on the radial side of the forearm. The upper section is located deep to the brachioradialis muscle, and the lower section descends between the brachioradialis tendon and the radial flexor carpi tendon. The pulsation can be felt under the skin at the wrist, and this is the location for clinical pulse diagnosis. Some people have a mutated radial artery, with the lower section running along the back of the radius, which is called the Fan Guan pulse in traditional Chinese medicine. The lower end of the radial artery goes around the radial styloid to the back of the hand, then passes through the first metacarpal space into the deep surface of the palm, and participates in the formation of the deep palmar arch.

Branches of the radial artery:

1) The superficial palmar branch originates from the radial artery at the radiocarpal joint and enters the palm to form the superficial palmar arch.

2) The main thumb artery is divided into three branches that are distributed to the thumb and radial side of the index finger.

(3) The ulnar artery runs down between the flexor carpi ulnaris and the superficial flexor digitorum on the forearm and enters the palm. Its terminal branch anastomoses with the superficial palmar branch of the radial artery to form the superficial palmar arch. The main branch of the ulnar artery is the deep palmar branch, which forms the deep palmar arch with the terminal branch of the radial artery.

1) The superficial palmar arch is located superficial to the palmar flexor tendon and is formed by the anastomosis of the terminal branch of the ulnar artery and the superficial palmar branch of the radial artery. Four arteries emerge from the convex side of the arch. The three radial branches are called the common palmar digital arteries. Each branch is divided into two proper palmar digital arteries, which are distributed on the opposite edges of the 2nd to 5th fingers. The innermost branch supplies the inner edge of the little finger.

2) The deep palmar arch is located deep to the palmar flexor tendon and is formed by the anastomosis of the deep palmar branch of the ulnar artery and the terminal branch of the radial artery. Three arteries arise from its convex side and anastomose with the common palmar digital artery of the superficial palmar arch.

4. Subclavian artery

It originates from the brachiocephalic trunk on the right and from the aortic arch on the left. It bends outward from the upper opening of the thorax, passes between the clavicle and the first rib, and transforms into the axillary artery at the outer edge of the first rib.

Major branches of the subclavian artery:

(1) The vertebral artery originates from the subclavian artery, passes through the transverse foramina of the 1st to 6th cervical vertebrae, enters the cranial cavity through the foramen magnum, and is distributed to the brain and spinal cord (see Central Nervous System for details).

( 2) The internal thoracic artery arises from the subclavian artery and descends behind the 1st to 7th costal cartilages (1 cm from the lateral edge of the sternum). Its terminal branch penetrates the diaphragm and enters the rectus abdominis sheath, where it is renamed the superior epigastric artery. The artery branches to the anterior chest wall, pericardium, diaphragm and rectus abdominis muscle.

(3) The thyrocervical trunk is a short and thick trunk whose main branch is the inferior thyroid artery, which runs inward and upward across the common carotid artery and behind it to the thyroid gland.

Detection method:

Generally, the patient is in the supine position, with the limb being abducted and externally rotated, the palm facing upward, and the limb being examined naturally relaxed. Start from the supraclavicular fossa and scan downward continuously horizontally and vertically.

The main arteries of the upper limbs are: subclavian artery, axillary artery, brachial artery, radial artery, and ulnar artery.

The deep venous system of the upper limb runs along with the arteries of the same name, and can be seen in the upper limb arteries by ultrasound examination; the superficial venous system includes the cephalic vein, basilic vein, median cubital vein and median forearm vein.

Normal sonographic appearance:

Artery: The three-layer structure of the arterial wall is clearly visible, the inner membrane has a slightly strong band-like echo, the middle layer has a lower echo, the outer membrane has a strong light band echo, and the lumen cannot be compressed.

Vein: The blood vessel wall is thin, the inner membrane is flat, and the blood flow in the lumen is echoless. Generally, the inner diameter of the vein is larger than that of the accompanying artery. During deep inspiration or Valsalva maneuver, the inner diameter of the vein widens. Most valves are bicuspid, with their bases attached to the venous wall.