Prevalence and Clinical Significance of Limb Arterial Variations: A Systematic Review and Proportional Meta-Analysis...

Background/Objectives: Anatomical variation of the limb arteries is a recurrent threat to safe surgical and interventional practice, yet it is frequently under-emphasized in modern curricula. Methods: We conducted a systematic review and proportional meta-analysis, following the PRISMA 2020 and Evidence-Based Anatomy methodology, to generate pooled prevalence estimates for the principal limb arterial variants and translate them into an educational framework. Six databases were searched from inception to December 2024; two reviewers independently assessed eligibility and methodological quality (AQUA tool); and proportions were pooled using the Freeman-Tukey double arcsine transformation under DerSimonian-Laird random-effects models. Results: Of 2847 records, 57 studies (23,267 limbs) were included. Pooled prevalence was 11.1% (95% CI 9.2-13.1) for high-origin radial artery, 2.6% (1.9-3.3) for superficial ulnar artery, 12.2% (6.5-19.2) for persistent median artery, 10.4% (9.1-11.9) for popliteal branching variants, and 0.8% (0.3-1.5) for peronea magna. Variation thus affects roughly one in five upper limbs and one in ten lower limbs-common enough to warrant deliberate curricular attention. Conclusions: We propose a four-principle framework (embryological reasoning, clinical-consequence integration, systematic identification, and competency-based assessment) for embedding variation recognition across the surgical training continuum.