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Good evening, and thank you for your question.
We've attached some related professional practice guidelines below that you may find useful if you are establishing or reviewing a local protocol.
An example of a department protocol (this is shared as an example of local practice, and is to be considered alongside current professional guidance and local clinical requirements)
For suspected arterial TOS, a combination of duplex ultrasound and physiological testing is performed.
The subclavian artery and axillary artery are assessed within the scalene triangle, costoclavicular space and the retropectoralis minor space. Provocative manoeuvers are applied at all three spaces.
These include - Neutral, ROOS Test, Military brace position, Adsen Test, Modified Adsen, Allen's Test and a Wright Test (you can search these individually for further information). Outside these standard tests, any position that recreates symptoms is also included.
It's important to recognize that neither duplex nor physiological findings should be interpreted in isolation. As positional vascular compression can also occur in asymptomatic individuals, clinical correlation—including whether the patient’s usual symptoms are reproduced—is particularly important.
The central veins are tested with the patient supine to exclude compression and obstruction.
https://www.svu.org/wp-content/uploads/2026/09/Upper-Extremity-Arterial-Duplex-Evaluation-2026.pdf
https://www.svu.org/wp-content/uploads/2026/09/Upper-Extremity-Arterial-Segmental-Physiologic-Evaluations-2026.pdf
https://www.csvs.org.uk/resources/lower-limb-arterial-duplex-assessment/download/
https://www.jvascsurg.org/action/showPdf?pii=S0741-5214%2816%2930345-7
Thank you again for your question. Any further questions, please don't hesitate to reach out.
Kind regards,
Vascular SIG