Upper Extremity

Question 1

arm artery anatomy

Answer 1

subclavian -> axillary -> brachial –> radial, interosseous, ulnar

Question 2

arm venous anatomy

Answer 2

brachocephalic vein –> subclavian –> axillary –> deep brachial veins, cephalic/basilic veins –> median antebrachial vein

Question 3

basilic vein is located ___ and ___ to the brachial veins

Answer 3

superficial and medial

Question 4

risk of what nerve injury with placement of PICC in brachial vein?

Answer 4

median nerve

Question 5

thoracic outlet syndrome

Answer 5

compression of brachial plexus, subclavian artery/vein

Question 6

interscalene triangle

Answer 6

anterior scalene, middle scalene, first rib

contains brachial plexus and subclavian artery

NOT subclavian vein

Question 7

neurogenic thoracic outlet syndrome

Answer 7

mechanical compression of brachial plexus

Question 8

subclavian artery compression

Answer 8

hand/finger pain, numbness, paresthesia, coolness; worsen with arm abduction

Question 9

Adson’s maneuver

Answer 9

test for subclavian artery compression

radial artery palpated neutral position

patient head turned away while they inhale; radial pulse will be reduced

Question 10

causes of subclavian artery compression

Answer 10

cervical rib, accessory scalene muscle, enlargement of anterior scalene muscle, well developed musculature

Question 11

complications of subclavian artery compression

Answer 11

arterial mural thrombus, aneurysm, distal embolization

Question 12

treatment for subclavian arteyr compression

Answer 12

surgical thoracic outlet decompression, repair of subclavian artery

endovascular arterial thrombolysis

Question 13

Paget Schroetter syndrome

Answer 13

subclavian vein compression; upper exremity pain/swelling worse with effort

muscular young men; chronic compression causes intimal hyperplasia –> subclavian vein thrombosis

Question 14

Diagnosis of Paget Schroetter

Answer 14

venogram in neutral and abducted position

evaluate both sides

Question 15

treatment for Paget schroetter

Answer 15

thrombolysis; surgical thoracic outlet decompression

angioplasty, but no stenting since stents have high risk of failure

Question 16

subclavian steal

Answer 16

proximal stenosis/occlusion of subclavian artery

Question 17

presenting syndrome for subclavian steal

Answer 17

vertebrobasilar insufficiency/syncope exacerbated by arm exercise –> brachial artery insufficiency, extremity coolness, fingertip necrosis

Question 18

angiography findings of subclavian steal

Answer 18

early arterial phase: proximal flow-limiting lesion

later arterial phase: retrograde flow from vertebral artery into subclavian

Question 19

surgical fistula patency rate

Answer 19

85% at 3 years, takes months to mature

failure rate 30%

Question 20

fistula locations

Answer 20

radial artery to cephalic vein (wrist)

brachial artery to variable forearm veins

Question 21

late fistula failure reasons

Answer 21

venous outflow stenosis, perianastamotic venous stenosis

Question 22

PTFE

Answer 22

polytetrafluorothylene graft

synthetic graft between artery/vein

50% patency at 2 years, but can be used sooner than fistulas

Question 23

graft failure reason for PTFE

Answer 23

venous stenosis at the venous anastamosis or outflow vein

Question 24

pulsatile fistula with lack of thrill

Answer 24

venous outflow obstruction

Question 25

high access recirculation at dialysis

Answer 25

venous outflow stenosis

Question 26

weak pulse and poor thrill

Answer 26

arterial inflow stenosis

Question 27

pulseless fistula

Answer 27

thrombosed fistula

Question 28

treatment for venous outflow stenoses

Answer 28

angioplasty -high pressure or cutting balloons restore venous to brachial artery pressure ratio to < 0.4, palpable thrill/pulse

Question 29

hypothenar hammer syndrome

Answer 29

injury to ulnar artery as it crosses hamate --> intimal injury, thrombosis, aneurysm, psuedoaneurysm

Question 30

classic presentation of hypothenar hammer syndrome

Answer 30

jackhammer operator with ischemia of 4th/5th digits

Question 31

Raynaud disease

Answer 31

small arterial vasospasm triggered by cold temperature decreased perfusion of distal digital arteris with improvement upon warming/vasodilator administration

Question 32

association with Raynaud

Answer 32

scleroderma and other connective tissue disorders

Question 33

cause of thromboembolic disorders

Answer 33

cardiac emboli (A fib); subclavian artery aneurysm thrombus bilateral disease = central reason such as heart