Abstract

Background: The superficial veins of the upper limb are the most frequently instrumented vessels in clinical practice, yet their configuration within the cubital fossa is inconstant between individuals. Such variability bears directly upon the safety of venipuncture, upon catheter placement, and upon selection of conduits for arteriovenous fistula construction. Methods: Six hundred and forty limbs from 320 adults were examined by surface mapping under cuff inflation with near-infrared transillumination. Configurations were assigned to six categories derived from an established classification. Prevalence was estimated using Wilson intervals, and associations with sex and side were examined by chi-square testing. Luminal calibre and the interval separating each vein from the median nerve were recorded. Results: The oblique configuration predominated, occurring in 52.5% of limbs, followed by the classical branching configuration in 24.1%. Distribution varied significantly with sex but not with side, and bilateral concordance reached only 68.1%. The median cubital vein proved the most capacious and most readily visualised channel, whereas the basilic vein lay nearest the median nerve and the cephalic vein farthest from it. Conclusion: Antecubital venous configuration is sufficiently variable that every limb warrants individual assessment before instrumentation, particularly where vascular access surgery is being actively contemplated.

Keywords: Cubital foss, Median cubital vein, Venipuncture, Arteriovenous fistula, Anatomical variation