Arteriography Upper Extremity Conventional catheter-based arteriography is effective at locating the exact point of vascular compression. In order to perform complete arteriography, catheter injection of contrast must be made from the aortic arch or the proximal subclavian artery. Injections and digital subtraction angiographic acquisitions are performed in both the neutral and abducted positions to assess dynamic changes. Vascular access is typically obtained from the femoral artery, although a radial artery approach can be considered. Even as a diagnostic tool alone, arteriography carries some risk. Because of its invasive nature and lack of information regarding surrounding structures, catheter-based angiography is largely only pursued if an endovascular intervention is envisioned. In the postintervention setting, catheter arteriography can provide definitive evaluation of arterial compression, occlusion, or other complication, such as dissection or aneurysm formation. This modality has the added advantage of possible immediate endovascular intervention. Catheter Venography Upper Extremity Diagnostic venography is not optimized for arterial evaluation. If there are overlapping symptoms, review of the other Variants in this document may help with protocol optimization. CT Chest For noncontrast CT, the goal is to demonstrate anatomical narrowing that could cause vascular compression. Findings include effacement of fat within the respective space and distortion or narrowing of the space with provocative or stress positioning. In a comprehensive study [13], a statistically significant difference was found between the distribution of the distances measured in the neutral and abducted positions in patients with arterial stenosis versus those without arterial stenosis. CT without IV contrast may be performed in the postintervention setting to evaluate interval changes in the thoracic outlet and assess adequate decompression.
Thoracic Outlet Syndrome. Arteriography Upper Extremity Conventional catheter-based arteriography is effective at locating the exact point of vascular compression. In order to perform complete arteriography, catheter injection of contrast must be made from the aortic arch or the proximal subclavian artery. Injections and digital subtraction angiographic acquisitions are performed in both the neutral and abducted positions to assess dynamic changes. Vascular access is typically obtained from the femoral artery, although a radial artery approach can be considered. Even as a diagnostic tool alone, arteriography carries some risk. Because of its invasive nature and lack of information regarding surrounding structures, catheter-based angiography is largely only pursued if an endovascular intervention is envisioned. In the postintervention setting, catheter arteriography can provide definitive evaluation of arterial compression, occlusion, or other complication, such as dissection or aneurysm formation. This modality has the added advantage of possible immediate endovascular intervention. Catheter Venography Upper Extremity Diagnostic venography is not optimized for arterial evaluation. If there are overlapping symptoms, review of the other Variants in this document may help with protocol optimization. CT Chest For noncontrast CT, the goal is to demonstrate anatomical narrowing that could cause vascular compression. Findings include effacement of fat within the respective space and distortion or narrowing of the space with provocative or stress positioning. In a comprehensive study [13], a statistically significant difference was found between the distribution of the distances measured in the neutral and abducted positions in patients with arterial stenosis versus those without arterial stenosis. CT without IV contrast may be performed in the postintervention setting to evaluate interval changes in the thoracic outlet and assess adequate decompression.