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Review
. 2021 Nov;22(1_suppl):9-17.
doi: 10.1177/11297298211046827. Epub 2021 Sep 27.

Upper limb anatomy and preoperative mapping

Joaquim Vallespin  1 , Mario Meola  2 , Jose Ibeas  3
Affiliations
Review

Upper limb anatomy and preoperative mapping

Joaquim Vallespin et al. J Vasc Access. 2021 Nov.

Abstract

Vascular access is absolutely essential for haemodialysis due to its relationship with quality of dialysis and associated morbidity. Therefore, it must be monitored and continuously surveilled from the moment it is created to prevent failure in maturation and thrombosis. Multidisciplinary collaboration is necessary when the main aim is to achieve the adequate vascular access flow with the fewest possible complications. The starting point, and probably the main one, is vascular access planning. This planning requires both a deep understanding of the anatomy of the upper limb and enough skill to examine it by Doppler ultrasound. The aim of this article is to review the anatomical and haemodynamical concepts of the arterial and venous vascular tree and explain how to perform ultrasound mapping, optimising the technical resources provided by this tool. Likewise, adequate access creation criteria that minimise the risk of failure and associated complications will be discussed.

Keywords: Ultrasonography – Doppler evaluation; anatomy; artery; atlas; dialysis access; haemodialysis; haemodynamics; maturation; preoperative mapping; vascular access; vein.

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Conflict of interest statement

Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Atlas of the arterial and venous vascular bed.
Figure 2.
Figure 2.
B mode. (a) Arterial examination. Radial and ulnar arteries with their respective satellite veins. (b) Venous examination. Diameter measurement.
Figure 3.
Figure 3.
Doppler mode in arterial examination: (a) triphasic morphology with high resistance flow and (b) reactive hyperaemia. PSV: peak systolic velocity; EDV: end diastolic velocity.
Figure 4.
Figure 4.
Doppler mode in venous examination. Respiratory phasicity.
Figure 5.
Figure 5.
Doppler mode in venous examination. Transmitted heart pulsatility.
See this image and copyright information in PMC

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