Tracking venous anatomical variation of the upper limb for optimal placement of arteriovenous fistulas in hemodialysis patients (543.10)

Abstract

The National Kidney Foundation Disease Outcomes Quality Initiative (KDOQI) guidelines support placement of arteriovenous (AV) fistulas in hemodialysis patients over grafts. Long‐term outcomes of AV fistulas are variable and access site failure remains a major factor in morbidity of hemodialysis patients. Preoperative sonographic mapping of anatomic variation and vessel diameter may prolong the success of native AV fistulas. This study examines venous anatomy of 96 cadaveric upper limbs from SUNY Downstate medical school anatomy laboratory. The vessel diameters of the cephalic and basilic veins were documented at specific landmarks along their respective courses. Normal and variant venous anatomy were compared and gender differences were evaluated. Results showed the normal anatomical condition in 55% of limbs. Among the remaining 45% of limbs, the duplicate cephalic system was the most frequent variant, representing 23% of the sample. Males exhibited greater frequency of anatomic variants and females had significantly smaller vein diameters than males in both the basilic and cephalic veins (p < 0.05). In all but the upper cephalic location, anatomical variants exhibited smaller vein diameters than those cadavers that had normal anatomy. Further investigation is warranted into relationships among rate of AVF construction failure, venous width, and drainage pattern.