Anatomical traps for arteriovenous fistula creation

The risk of complications in undisclosed vascular variability appears relatively likely. Therefore, it is important to assess the probability of encountering anatomical-topographic variability in the venous system of the upper limb. The catalogue of patterns of the upper limb venous system seems to be unlimited and should therefore be constantly updated. The aim of the study was to explore the venous system of upper extremity and discuss some problems that would be encountered with the formation of an arteriovenous fistula.

In 17 (85%) explored upper limbs, the venous system showed a pattern similar to the reports already described. But in (15%) 3 of them, the venous system showed certain differences in relation to the accepted anatomical textbooks. Especially in one of them the anatomical variant of basilic and cephalic vein contrasted distinctly with the other veins. Based on the revealed anomalies, a statistical analysis of the probability of occurrence of any anatomical variant and the risk of complications associated with fistula creation was conducted. Even on such small group an assessed probability of anatomical variability of the upper limb venous system was statistically significant at p < 0.0244 (odds ratio 0.0828; 95% confidence interval 0.0095-0.7252).

The probability of any anatomical-topographic variability in the venous system of the upper limb should be considered as statistically significant. Only intense anatomical dissections would undoubtedly help to avoid some anatomical traps and then minimise some complications in the creation of arteriovenous fistulas.