A patient assessment must be performed before the evaluation. This includes an assessment of the patient's ability to tolerate the procedure, an evaluation of any contraindications to the procedure, and a physical assessment of bilateral arms, hands, and fingers. The sonographer or examiner should obtain a complete, pertinent history and a review of the patient's medical record, if available. A pertinent history includes:

• Previous vascular/cardiovascular surgeries
• Current medications or therapies
• Risk factors for arterial disease:
  • Diabetes
  • Hypertension
  • Hyperlipidemia
  • Coronary artery disease
  • Age
  • Smoking history
  • Connective Tissue Disease such as Scleroderma, Systemic Lupus Erythematosus, and CREST syndrome.
• Type of job/hobby (especially if the examination is for TOS or arm/hand trauma).
• Physical assessment of the arms, hands, and fingers for symptoms of limb ischemia, skin changes (including duration, location, and whether it is persistent or episodic), gangrene, and/or ulcers.

A complete assessment should guide the sonographer to:

• Verify that the procedure ordered correlates with the patient’s clinical presentation.
• Determine if upper extremity arterial physiological evaluation should be included in the examination.
• Perform adjunctive procedures according to the laboratory-specific protocol: auscultation of bruits, palpation of pulses and/or Allen's test.