Abstract
Objectives
We sought to (1) to determine prevalence of high brachial artery bifurcation, forearm cephalic-arm cephalic connection, forearm cephalic-arm basilic vein alternate connection, and levels of basilic-brachial vein junction; and (2) to compare average diameters of forearm and arm cephalic and basilic venous segments according to the results of ultrasound mapping of the upper extremities (UE).
Methods
Consecutive ultrasound mappings were performed in 100 UE of 23 women, 69 ± 12 (47–84), and 27 men, 62 ± 12 (34–79) years of age. Brachial, radial and ulnar arteries and cephalic and basilic veins were scanned from wrist to axilla.
Results
Brachial artery bifurcation at the proximal/mid arm was noted in 25 UE of 18 subjects. Arm (a) or forearm (f) cephalic (ce) or basilica (ba) veins were absent in 18 (ace), 15 (fce), 10 (aba), and 14 (fba) UE, respectively. A forearm cephalic-arm cephalic vein connection was noted in 67 UE; of these, 9 (13.6%) also had a significant forearm cephalic-arm basilic connection. A primary forearm cephalic-arm basilic connection was noted in 5 UE, one with a secondary connection to the arm cephalic vein. The basilic joined the brachial vein at the proximal, proximal-mid, mid, mid-distal and distal arm in 29, 17, 26, 4, and 2 UE; a complex connection to radial/ulnar veins was noted in 14 UE. Average diameters were 4.2 ± 1.4 (1.2–7.8), 3.1 ± 1.1 (0.6–6.3), 2.9 ± 0.9 (1.4–4.9), and 2.2 ± 0.9 (0.7–4.5) mm for the arm basilic, arm cephalic, forearm cephalic and forearm basilic veins.
Conclusions
A significant prevalence of anatomical anomalies was noted, justifying mapping of the upper extremity vasculature prior to planning an arteriovenous fistula or prosthetic graft in patients with end-stage renal disease.
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