Diagnosis of veins of the upper extremities - duplex scanning. When is ultrasound of the veins and arteries of the upper extremities necessary: ​​what is it, indications and explanation Indications and contraindications

Duplex scanning of blood vessels (USDS) is a method ultrasound diagnostics, which combines Doppler ultrasound with traditional ultrasound. It is used to study the pathology of blood vessels - veins and arteries. It allows the specialist to see the structure of blood vessels various localizations and the movement of blood through them.

A standard ultrasound scan provides a two-dimensional image (structure and developmental anomalies) of the vein. The Doppler mode reveals the direction of blood flow and the speed of its movement. An even more advanced method is triplex scanning. It combines B-mode, color doppler mapping and spectral Doppler analysis.

In modern medical institutions the patient can pass duplex scanning vessels of the upper and lower limbs, and also do Dopplerography of the vessels of the head and neck. Duplex vein scanning upper limbs performed less frequently than the lower ones, but it makes it possible to detect vascular diseases on early stages, even with a mild clinical picture or complete absence symptoms.

Indications and contraindications

It is recommended to undergo an ultrasound scan of the arteries and veins of the upper extremities in the following cases:

• Swelling of the hands with redness of the skin and severe pain. Although stable edema, as an independent symptom, with normal functioning of the kidneys and heart can be a reason for duplex scanning.
• Numbness of the upper extremities, periodic tingling, “goosebumps” and others discomfort.
• Difficulty in moving your arms and developing weakness in them.
• Frequent involuntary muscle contractions as a result of overexertion.
• Pallor of fingers with periodic painful sensations.
• Serious injuries to the upper extremities, which entail damage to vascular bundles.
• After vascular surgery.
• At congenital anomaly vein development

This examination should be carried out in for preventive purposes people at particular risk. As a rule, they have the following pathologies: endocrine diseases, blood diseases, autonomic dysfunction, chronic diseases veins, hereditary predisposition to vascular pathologies.

Duplex scanning of the veins of the upper extremities does not have absolute contraindications to carry it out. Relative ones include significant damage to the skin of the upper extremities, which can make it difficult to apply the ultrasound sensor to the skin.

Ultrasound scanning of vessels upper extremities can be performed as often as necessary to make a correct diagnosis and provide adequate therapy. Negative consequences for the patient's body the frequency of such examination is not expected.

Even if a blood flow problem is suspected in only one arm, both limbs are still checked for comparison.

Performing diagnostics

No special preparatory period is required for ultrasound scanning of the veins of the upper extremities. Immediately before the examination in the ultrasound diagnostic room, the patient is asked to free his hands from clothing (sometimes it is appropriate to undress to the waist) and remove jewelry and other items that may interfere with the examination.

In the ultrasound diagnostic room, the process will occur as follows:

1. The examination is carried out in a supine or sitting position. In some cases, it is advisable to measure arterial pressure, so a blood pressure cuff is placed on one or both of the patient’s arms.
2. The ultrasound doctor lubricates the high-frequency sensor with conductive gel and begins to move it along the arm in the area of ​​the venous projection.
3. By changing the position of the ultrasound sensor, the specialist assesses the condition of the vessel wall and measures blood movement indicators.
4. During the diagnostic process, the doctor may squeeze the patient's shoulder or forearm to speed up the movement of blood through the veins, thereby assessing cardiac blood flow.
5. The resulting image is instantly processed and displayed on the monitor screen.
6. In some cases, it is enough to examine one limb, but in some patients 2 arms are examined at once.

Duplex scanning of the veins of the upper extremities continues for 30-40 minutes. After the examination is completed, the patient can be freed immediately. There are no subsequent restrictions. Such medical manipulation It is absolutely safe for the patient, it does not involve any complications or side effects.

During the diagnostic process, the patient does not experience pain syndrome or severe discomfort. He may feel a slight cooling sensation from the ultrasound gel when applied to his skin. But this can be avoided if you first warm the gel to body temperature. And also if blood pressure is measured during the examination, the tonometer cuff will be inflated and the patient will feel tension in this area.

Duplex (triplex) scanning is considered the standard in vascular research and to some extent can replace angiography, which requires the administration of contrast and exposes the patient to radiation.

Varicose veins on the hands are unlikely, but the possibility exists

Decoding the results

As a result of examining the veins of the arms, the protocol contains few digital indicators, but includes the following parameters:

• anatomical structure;
• patency of venous vessels;
• the speed of blood flow through them;
• the presence of abnormal formations in the lumen of the vessel.

Normal ultrasound performance indicators in conclusion are indicated as follows. There are no obstructions to blood flow in the veins examined. The veins are of normal location and are not enlarged in size. Not detected in the examined vessels blood clots.

If pathology is present, then during ultrasound scanning an asymmetry of blood flow between opposite parts of the patient’s body is detected. If the blood flow is blocked in any area, then during listening in this place a high-pitched and sharp sound will appear. In this case, the blood will move at a reduced speed. The detected obstacle may be a blood clot, partial or complete narrowing of the lumen of the vessel, or an aneurysm.

Duplex scanning of the hands allows the specialist not only to detect blood clots and dissections in the vessels of the upper extremities, but also to easily determine their location, size and structure. Ultrasound scanning allows examination from the standpoint of quantitative and qualitative parameters of blood flow, which ultimately helps the phlebologist determine further treatment tactics.

Ultrasonography(Ultrasound) of superficial and deep vessels of the upper extremities makes it possible to identify blood flow disturbances, deformation, and narrowing of the lumen of the arteries and veins of the arms. This diagnostic procedure is performed different ways depending on what disease the doctor suspects.

Ultrasound is based on the property of ultrasonic waves to be reflected differently from media with different densities and from moving objects. The ultrasound machine's sensor simultaneously generates and receives ultrasound, transmitting the result to the monitor.

The simplest option for studying blood flow in the veins and arteries of the upper extremities is Doppler ultrasound or abbreviated as ultrasound. It shows the speed of blood flow in black and white without visualizing the vessel itself. Ultrasound ultrasound is used if the cause of the disease is known; you just need to assess how much the blood flow suffers against its background.

If it is important to put correct diagnosis or track dynamics pathological process, then preference is given to color duplex or triplex scanning of the vessels of the upper limb. This examination method simultaneously shows the condition of the vascular wall and the characteristics of blood flow along the vascular bed in a visual form. At the same time, a color change is observed on the monitor screen: blood flow directed towards the sensor is displayed in red, and in blue – in the opposite direction.

Indications and contraindications

Indications for ultrasound examination are:

• swelling, redness, pain in the upper limb;
• numbness, burning of the skin of the hands, a feeling of “crawling goosebumps”;
• pallor and excessive dryness of the skin, its peeling;
• trophic ulcers of the skin and soft tissues of the extremities;
• weakness, increased fatigue of the arm muscles;
• the presence of atherosclerotic plaques in the vessels;
• blood coagulation pathology with an increased risk of thrombosis;
• suspected injury to the blood vessels of the hand;
• possible deformations or abnormalities in the structure of blood vessels (tortuosity, aneurysms, varicose veins).

Duplex scanning of the deep and superficial veins of the upper extremities is often performed for thromboembolism pulmonary artery to identify the possible source of the detached thrombus.

There are no absolute contraindications to ultrasound. There are only time restrictions that make the diagnostic procedure difficult:

• mechanical damage or thermal burn skin in the area to which the sensor is applied;
• rash on the skin of the hands of an infectious or allergic nature;
• state of motor mental arousal in the patient.

Once these problems are resolved, diagnosis becomes possible.

Preparation and procedure

There is no need to prepare in any special way for ultrasound examination of the vessels of the upper extremities, neither for ultrasound scanning nor for duplex scanning. Before the procedure, it is not recommended to smoke, drink coffee or strong tea, as they can provoke vasospasm. Nitroglycerin, on the contrary, dilates the arteries. However, if necessary, you should not refuse to use it.

You need to take it with you to the examination outpatient card, a referral for an ultrasound, an insurance policy, a towel or napkins. Before the examination, the doctor will ask you to remove your watches and jewelry.

The procedure is carried out lying down or sitting. A neutral gel is applied to the skin to improve the visual signal and facilitate the sliding of the sensor. The doctor moves the sensor along the upper limb, examining the vessel, identifying its possible deformations, blockage, and the presence of plaques - cholesterol deposits. In addition, hardware measurements of blood flow speed, vascular wall thickness, and vascular bed lumen width are carried out.

In some cases, the sonologist conducts tests for vascular reactivity: he asks to tense his hands or squeezes a limb at different levels.

All manipulations take about half an hour. The conclusion is usually given immediately. No complications were observed after the ultrasound.

What does an ultrasound show and what result is considered normal?

The doctor enters the results of the following parameters into the examination protocol:

1. Blood flow speed. It is different for vessels of different calibers and types. Normally, blood flows through veins more slowly than through arteries. Pathological slowing of blood flow in the extremities is observed with venous thrombosis, superior or inferior vena cava syndrome, and malfunction of venous valves. Acceleration of blood flow is characteristic of vascular spasm.
2. Direction of blood flow. Swirls in the area of ​​vessel branching are considered normal. However, it must be taken into account that in other areas they indicate obstructions to blood flow, deformation, and pathological tortuosity.
3. Vessel shape. In the presence of aneurysms and varicose veins, the vessels become uneven, their local expansions and deformations appear.
4. Dimensions of the lumen of the vascular bed. Uniform narrowing is characteristic of vascular spasm. Local narrowing without changing the vascular wall - to compress it from the outside by a tumor, displaced bone, or tendon.
5. The presence of pathological formations in the vessel cavity - atherosclerotic plaques, blood clots, calcifications, foreign bodies.
6. Vessel wall thickness. Fine upper limit the norm for this indicator corresponds to 1.0 mm. When it increases, they speak of the development of atherosclerosis. Thinning of the vascular wall is often observed in the area of ​​the aneurysm and indicates the risk of its rupture.

It must be taken into account that the resolution depends on the type of device and sensor, therefore, in doubtful situations, the doctor prescribes a more accurate examination - one of the options for angiography.

A doctor of any specialty can refer a patient for an ultrasound scan of the veins or arteries of the upper extremities: therapist, surgeon, cardiologist, phlebologist. According to the results comprehensive survey the doctor will prescribe treatment. Sometimes, after a course of therapy, a repeat ultrasound is recommended to assess its effectiveness.

Ultrasound of the vessels of the upper extremities is an examination of the veins and arteries of the shoulder and forearm, which makes it possible not only to study their anatomical data, but also to establish such parameters as the speed of blood flow and its quality. This type of diagnostics is considered one of the most informative, and most importantly, safe.

Modern medical equipment involves several types of procedures. Duplex scanning combines traditional ultrasound, which allows one to study the structure and diagnose vascular abnormalities, with Doppler imaging, which makes it possible to assess the characteristics of blood flow. In addition to the listed functions, triplex scanning includes color Doppler mapping.

• soreness in the shoulder or forearm and hardening of the veins;
• swelling of the hands and muscle pain;
• cramps, tingling, sensory disturbances;
• cold palm syndrome;
• diabetes;
• trophic ulcers;
• high cholesterol;
• venous or arterial insufficiency;
• previous upper limb surgeries.

Ultrasound is used to diagnose diseases such as:

• atherosclerosis;
• thrombosis and thrombophlebitis;
• Raynaud's disease;
• angiodysplasia;
• vasculitis;
• endarteritis;
• superior vena cava syndrome.

Absolute contraindications to this species there is no survey. However, there are a number of conditions in which it is advisable to postpone the procedure if there are no grounds for urgent diagnosis. It is not advisable to conduct research if:

• ARVI, especially in the presence of fever;
• allergic manifestations: rashes, itching;
• burns;
• nausea and vomiting;
• hypertension;
• migraine;
• overwork.

This diagnostic method does not lead to complications and is suitable even for pregnant women and children.

Preparation for the procedure

Such a study is non-invasive and does not require any special training. It is not recommended to do it on an empty stomach; it is advisable to eat a light meal shortly before the procedure. On the eve of the examination day, it is necessary to avoid excessive physical activity, it is important to try to get enough sleep.

It is advisable to avoid consuming foods that can affect the condition of blood vessels, such as:

• coffee;
• energy.

You should exclude them from your diet and, in addition, refrain from smoking at least a day before the procedure.

When and how to do it

The duration of duplex scanning of the veins of the upper extremities ranges from 20 to 40 minutes. The procedure takes place in the following order:

• the phlebologist interviews the patient and studies his medical history;
• the patient’s hands are freed from clothing and jewelry;
• the subject takes a horizontal position;
• Conductive gel is applied to the area to be examined;
• the doctor puts the sensor on control points corresponding to the vessels being examined, and studies the image on the device screen, while at the same time analyzing the sounds of blood flow recorded by the device;
• are carried out functional tests for diagnosing circulatory disorders;
• the remaining gel is removed with a napkin.

To study the shoulder and forearm, a linear sensor operating at a frequency of 7.5 MHz is used. Diagnosis of the hand is carried out with a sensor having a frequency of 13.5 MHz.

The procedure starts with armpit, then the sensor gradually moves to the ulnar fossa, and after that - to the palmar surface of the hand. During the study, the diameters and indicators of blood flow in the subclavian, brachial, ulnar and radial arteries and accompanying veins.

At the end of the study, the protocol is issued in printed form and is supplemented with images of pathological areas.

Decoding the results: normal and pathological

When conducting ultrasound examination the doctor analyzes the condition of the walls, determines the depth of the lumen of the veins and arteries and the functionality of their valves, identifies existing blood clots, and determines blood flow parameters.

The main quantitative indicators recorded during the procedure include:

• minimum and maximum blood flow velocities recorded during systole;
• vascular resistance;
• pulsation index;
• thickness of internal and middle shells vessels.

In addition to the digital assessment, the examination protocol contains information about anatomical structure and patency of blood vessels and the presence of abnormal formations in their lumen.

Blood flow assessment

Using duplex scanning of the veins of the upper extremities, areas of decreased blood flow are identified and the degree of impairment is established. If the patient has any pathologies, then during Doppler sonography the asymmetry of blood flow in opposite parts of the body is recorded. When scanning an area with blocked blood flow, a sharp high-frequency sound is generated and a drop in blood flow speed is recorded.

Normal blood flow is characterized by a decrease in linear velocity in the direction from the proximal to the distal segments of the upper extremities and high peripheral vascular resistance. The phlebologist also compares the readings obtained at rest and under load. In the absence of pathologies, they should differ by 10-40%.

Disturbances and narrowing

Duplex scanning of the arteries of the upper extremities makes it possible to diagnose narrowing of the lumen of blood vessels. The presence of thickenings and irregularities on the walls is a symptom of disease. It is not enough to state the fact of narrowing. It is important to determine the severity of this condition.

Detection of a blood clot

The use of color ultrasound technology makes it possible to detect blood clots and dissection of vessel walls, and to detect the formation of atherosclerotic plaques. The presence of a blood clot in the lumen of a vein or artery is the main cause of blockage of blood vessels, leading to impaired blood flow. Existing techniques examinations allow not only to find the exact location of the blood clot, but also to determine its structure and size, as well as establish the causes of its occurrence.

If significant pathologies are detected, the patient may be prescribed additional examinations. It is possible that for full diagnostics state vascular system body, the patient will be recommended to examine his legs in addition to his hands. Often, when severe narrowing of the arteries of the upper extremities is detected, a study of the main arteries of the head is prescribed, especially in cases where the patient suffers from headaches.

Because the human body is complex, and all its systems are interconnected, as a result of vascular ultrasound there is a high probability of revealing that the cause of the patient’s symptoms is not a violation of the blood supply. Then an examination of other organs will be prescribed, the pathologies of which may give a similar clinical picture. For example, a patient may be offered a diagnosis inner ear, MRI of the whole body or other procedures.

The First Doctor network of clinics in Moscow are modern medical centers where you can do ultrasound scanning of veins. The clinic's specialists have high level competence in treatment and diagnostics vascular diseases hands Research is carried out on modern devices using high-precision duplex methods - scanning that combines the capabilities of Doppler ultrasound and classical.

Medical indications for prescribing ultrasound of the veins of the upper extremities

Diagnostics is prescribed to patients in whom, during a consultative examination with a therapist, surgeon or angiosurgeon, the following were determined: pathological disorders in the venous system of the arms:

• thrombosis;
• phlebitis;
• thrombophlebitis;
• congenital form of defects in the development of blood vessels;
• varicose veins;
• injuries with suspected damage to large venous trunks;
• observation after surgical interventions on vessels or near areas of interest.

Ultrasound of the veins of the arms may also be prescribed before performing surgical interventions in the area of ​​the upper extremities and at the stages of postoperative rehabilitation.

Symptoms of diseases of the venous system of the hands

1. It is recommended to assess the condition of the blood vessels in the hands when the following group of signs appears:
   • muscle weakness and numbness in the arms;
   • change in temperature and shade of the skin of the hands (blueness, pallor);
   • the appearance of dense relief and convexity of the venous network of the upper extremities;
   • swelling of hand tissues with in good condition functioning of the heart and kidneys.

Preparation and progress of the ultrasound scanning procedure

An ultrasound scan of the veins of the upper extremities does not require advance preparation. During the procedure, the patient is asked to remove clothing from the arms and shoulder girdle area; it is also necessary to remove all jewelry that may interfere with the procedure. Manipulations are performed while sitting or lying down. The specialist applies a small amount of lubricating gel to the areas of the body being examined and places the scanner sensor on it.

When the position and angle of the reading device changes, the necessary characteristics of the space under study are displayed on the monitor screen, structural features vessels, the level of blood supply in the network is measured. Diagnostics is carried out on one hand, if necessary on two. After completing the examination, the doctor describes (deciphers) the data obtained and gives the conclusion to the patient.

Advantages of ultrasound diagnostics of arm veins at the First Doctor clinic

The clinics of the medical center use modern diagnostic equipment that allows obtaining a three-dimensional image of the vascular network in color format. Availability of progressive technical means in the hands of qualified specialists is the key to highly accurate and effective diagnostics, eliminating inaccuracies and errors. The duplex diagnostic methods used make it possible to identify venous pathologies at the earliest stages, when the general clinical picture not yet expressed.

Online medical centers"First Doctor" in Moscow is available to patients full list diagnostic services:

• hardware scanning using modern technical means;
• consultations with specialized doctors - angiologists, phlebologists, therapists;
• preparation of all necessary tests;
• carrying out related surveys.

At First Doctor clinics, patients save their time and receive high-quality medical service reasonable price. The institutions are located within walking distance from the Kutuzovskaya and Otradnoe metro stations. You can find current prices for services in the relevant sections of the website.