Anatomical variations in upper arm vasculature pertinent to haemodialysis access creation: Are surgeons aware sufficiently?

There exist wide anatomical variations of upper limb. Their implication is perhaps greatest when it comes to failure of arteriovenous fistula (AVF) for chronic haemodialysis. Among arteries of forearm, brachial artery is of note, whose high bifurcation is associated with increased risk of failure. The superficial and accessory variants also cause difficulty for the surgeon. The single unpaired brachial vein and stenosis of cephalic vein compound the difficulties associated with AVF among many others. A thorough understanding of surgeons regarding normal anatomy and diverse variants holds high importance in context of deciding an appropriate site for arteriovenous (AV) anastomosis. Negligence in creation of fistula not only pose a threat to patients of end stage renal disease (ESRD) but also contributes to numerous other complications involving nerves and drug administration.