Perforating veins: an anatomical approach to arteriovenous fistula performance in the forearm.

OBJECTIVES Arteriovenous fistulae (AVFs) play a key role for people who rely on chronic haemodialysis. Stenosis in the venous outflow of the AVF will cause an alternative route of the subcutaneous blood flow via the deeper venous pathways by means of side branches and the perforating veins (PVs). The purpose for the present study was to define the number and anatomical localisation of the perforating veins in the forearm. METHODS Twenty forearms were dissected to study the venous anatomy. The localisation, size and connections of the perforators were recorded and stored digitally. RESULTS In total, 189 PVs were defined (mean, 9.5 per arm; range, 6-19), with 60 (32%) PVs connected to the cephalic vein, 97 (51%) connections to the basilic vein and 32 (17%) PVs to the median vein of the forearm. Most PVs originate from the basilic vein and connect with the ulnar venae comitans. The cephalic vein connects equally to the radial venae comitans, interossea veins and the muscles. CONCLUSION The cephalic vein has the fewest PVs and almost a third of them connect to the muscles. This is probably important for the maturation of the AVF, the superficial flow volume and the accessibility for puncture.