High Radial Artery Origin Mistaken For Inflow Artery Obstruction In Radiocephalic Arteriovenous Fistula

Patient: A 41-year old woman Chief complaint: poor maturation of the AVF Present illness: She received radiocephalic AVF operation for planned HD 2 months ago. But the AVF didn’t muture well, we needed to evaluate the AVF Past medical history She diagnosed DM CKD 4 years ago, and made AVF on left lower arm. Imaging study and Clinical course In order to evaluate the AVF, we performed areteriography via arterial puncture just above the elbow joint. Radial artery showed no uptake of contrast dye and ulnar artery connected with the radial side of the palmar arch and formed an anastomosis with the cephalic vein. At first, we thought total obstruction of the radial artery had occurred. However, radial pulse was present and there were no ischemic changes in the hand. We performed a CT angiography to investigate whether anatomical abnormality or variation existed in the artery of the upper extremity. It showed the radial artery and the ulnar artery bifurcating at the proximal part of the upper arm and the radial artery was normally connected with the cephalic vein without obstructed lesions. Arteriography of the left upper arm via femoral artery puncture confirmed high bifurcation of the brachial artery with high origin of the radial artery. We decided to wait without surgical correction of the AVF. We started HD via successful needling via the AVF 1 month after the study. High origin of the radial artery is not uncommon. When performing brachial arteriography in HD patients with high origin of the radial artery, anomalous high origin of the radial artery may mislead clinicians to judge as total obstruction of the radial artery. Therefore, we conclude that CT angiography or arteriography of the upper arm via femoral artery puncture may be helpful in cases of suggested high origin of the radial artery.