Bilaterally Absent Cephalic Veins: A Case Study

Background: The cephalic vein (CV) is one of the primary veins of the upper limb. It is a superficial vein located on the anterolateral surface of the arm and is a common site for venous access. The typical course begins along the radial aspect of the wrist and forearm where it joins with the median cubital vein (MCV) at the antecubital fossa and continues proximally through the superficial fascia, lateral to the biceps brachii muscle, and into the deltopectoral groove of the shoulder. It terminates by draining into the axillary vein in the deltopectoral triangle. The absence of the CV or variations in its location could have important implications for vascular procedures, such as Arteriovenous (AV) fistulas, which utilize the CV as the primary vein for preparing patients for long-term hemodialysis access. Case Information: An elderly Caucasian male cadaver presented with complete bilateral absence of the CV proximal to the antecubital fossa. Dissection revealed enlarged basilic veins (BV) and MCVs that crossed superficially to the bicipital aponeurosis and continued distally along the anterolateral side of the forearms towards the hands. Both limbs also showed a small anastomosis between the large MCV and the deep brachial vein (DBV) just distal to the bicipital aponeurosis. The BV on the right limb gives off one branch as the MCV that continues along the radial aspect of the forearm. Additionally, two smaller branches emerge and circumvent the medial epicondyle of the humerus and rejoin to form one vein that continues along the medial aspect of the forearm. The left limb showed an interesting anastomotic ring within the portion of the vein that would normally represent the MCV just distal to the bicipital aponeurosis. In contrast to the right limb, there was only one smaller branch from the BV that coursed around the medial epicondyle and travelled along the dorsal aspect of the forearm. The absence of the CV in the deltopectoral groove of both shoulders was also noted. Conclusions: This cadaveric case study illustrates a unique presentation of the upper limb venous architecture. With a significant portion of the U.S population requiring hemodialysis and/or developing end-stage renal disease, there has been an increase in the number of AV fistula procedures performed each year. Therefore, having a greater awareness of the variations of the CV may help to prevent complications in vascular procedures that require its use.