Anatomy of Hemodialysis Access

Effective hemodialysis access requires an understanding of the anatomy of the arteries, veins, and nerves of the extremities. Arterial blood flows to the arm via the subclavian, axillary, brachial, radial, and ulnar arteries. While venous flow returns to the heart via the cephalic, basilic, and other superficial veins which drain into the deep venous system. Numerous vascular anomalies occur, including high origin of the radial artery and variations of superficial arm veins. Upper extremity vessels are intimately associated with major nerve structures, particularly the median nerve in the arm and the sensory nerves in the arm and wrist, and knowledge of their locations is important to reduce problems. Creation of durable hemodialysis access is challenging. A thorough knowledge of arterial and venous anatomy and awareness of nerve proximity are essential to avoid complications and optimize long-term success. In this chapter, we discuss normal arterial, venous, and nerve anatomy of the extremities, as well as the more common anomalies.