A Cadaveric Study of Radial Artery and Cephalic Vein in Forearm and Hand: A Guideline for Radio-cephalic Arteriovenous Fistula Planning

Abstract

Introduction: The creation and maintenance of uninterrupted Haemodialysis (HD) is dependent on the quality and reliability of vascular access. The native Radio-cephalic Arteriovenous Fistula (RCAVF) is the vascular access of choice for HD in patients with end stage renal diseases. A thorough understanding of the vascular anatomy is critical in selecting the site for the RCAVF that provides the flow rates necessary for the development of an optimal outflow vein. The widespread use of the doppler ultrasound has facilitated the identification of vessels that are suitable for fistula construction. Aim: To analyse the surgical anatomy of radial artery and cephalic vein in the front of forearm and dorsum of hand, pertinent to RCAVF planning. Materials and Methods: A cross-sectional cadaveric of 30 formalin preserved upper limbs specimens of adult human cadavers was done in the Department of Anatomy, Hamdard Institute of Medical Sciences, New Delhi, India, (n=22 limbs) from August 2016 to April 2018 and Government Institute of Medical Sciences, Greater Noida, Uttar Pradesh, India (n=8 limbs) from November 2018 to November 2019. The external diameter of radial artery, cephalic vein and distance between radial artery and cephalic vein were measured at mid forearm, front of wrist and Anatomical Snuff Box (ASB). Measurements were taken with sliding vernier caliper to an accuracy of 0.01 mm. All the measurements were tabulated separately for right and left-side. The data was analysed using Microsoft excel. Descriptive statistics like mean, standard deviation (SD) and range were evaluated for all the parameters collected. The paired t-test was applied to compare the right and left-side measurements. Results: Amongst 30 formalin preserved specimens of upper limbs of human cadavers analysed, the diameter of radial artery was 3±0.26 mm on the right-side and 2.87±0.24 mm on the left- side and of cephalic vein was 2.5±0.59 mm on the right-side and 2.9±0.33 mm in ASB. The distance between radial artery and cephalic vein were 2.5 ±0.59 mm on the right-side and 2.9±0.33 mm on the left-side which was minimum in ASB. The distance between radial artery and cephalic vein was maximum at wrist (4.02±0.76 mm and 4.2±0.71 mm on the right and left hand). Conclusion: The fistula formation in ASB may give better results as the radial artery and cephalic vein are closer as compared to wrist and midforearm with reasonable diameter. Additionally, it would also provide long segment of vein for arterialization.

Keywords

• anatomical snuff box
• end stage renal disease haemodialysis
• mid forearm
• vascular access
• wrist