Challenging creation of a hemodialysis arteriovenous fistula (AVF) in a patient with high division of the radial artery

The radial artery (RA), a branch of the brachial artery, is frequently utilized in a variety of medical procedures: by cardiologists for cardiac catheterization, by nephrologists for arteriovenous fistula creation, by interventional radiologists, and by plastic surgeons for free flap reconstruction. Knowledge of RA anatomical variants is particularly important in patients with end-stage renal disease, as they often require fistula creation for hemodialysis. Failure to recognize such variants may lead to procedural complications. We describe the case of a 35-year-old man with diabetes whose preoperative ultrasound examination, performed before the creation of an arteriovenous fistula, revealed a high division of the radial artery into the superficial radial artery and the deep branch of the radial artery. The deep palmar branch of the radial artery was successfully used for anastomosis in the wrist. In this publication, we provide the data regarding this rare anomaly and indicate that such a finding should not lead to abandoning the creation of a radial-cephalic fistula.