Diagnostic study of vascular lesions.

Detailed diagnostic evaluation of upper extremity vascular lesions is not possible with any single existing test or study. Arteriography and improved arteriographic techniques, including digital subtraction imaging, have increased dramatically the resolution of this procedure. Unfortunately, reactive vasospasm and limited run-off still preclude the provision of complete information about vascular anatomy. Surgical exploration, of course, provides direct access to arterial and venous structures in a limited area, but it has obvious limitations. Indirect information about the structural anatomy can be obtained by Doppler techniques, ultrasound scans, and radionuclide imaging. These techniques also provide limited information about changes in perfusion during stress. Plethysmography, thermography, thermometry, and measurements of segmental arterial pressure, when combined with stress testing, provide excellent indirect evidence of both static and dynamic states. A combination of pressure measurements and intraoperative ultrasound associated with direct surgical measurement will provide quantitative and qualitative analysis of antegrade and retrograde flow and allow the surgeon to look at the intima of vessels without surgically traumatizing the vessel wall. Within the next decade, real-time information with three-dimensional reconstruction of arterial and venous structures as well as quantitative analysis of segmental areas of blood flow will be provided by the use of combinations of these techniques or techniques that have not yet been reported.