Morphological characteristics of upper limb superficial veins in adults

Abstract

Background Anatomical variability of the superficial veins of the upper limb is an important and clinically significant topic in contemporary anatomy. Despite well-established basic schemes of venous drainage, numerous studies demonstrate a high frequency of individual and population-specific variations in vein course, calibre, branching patterns, and the structure of anastomoses. These variations have direct clinical relevance, influencing the outcome of venepuncture, catheterization, vascular access placement, as well as reconstructive and microsurgical procedures. Particular attention is given to variations in the cubital fossa and the presence of atypical venous connections, which are important for planning venous grafts, arteriovenous fistulas, and complex surgical interventions. Modern investigative methods, including anatomical, ultrasonographic, and angiographic studies, demonstrate a broad spectrum of variations, often influenced by demographic and population-specific factors. Studying these variations is also essential for medical education, as standard anatomical textbooks often fail to reflect the true diversity of the venous system. Systematic documentation of such data improves training of healthcare professionals and enhances the safety and effectiveness of clinical and surgical procedures. The aim of the study was to identify morphological variations of the superficial veins of the upper limb in adults for their application in clinical practice. Material and methods A study was conducted on 75 healthy young adults (36 females, 39 males, aged 18–23) for visualization of the superficial veins of the upper limb. A sphygmomanometer cuff was applied to the upper arm (130-140 mmHg) while participants repeatedly clenched and unclenched their fists, allowing the veins to fill and become visible through the skin. The veins were recorded using a digital camera. Macroscopic examination and statistical analysis were performed. Results The study identified multiple anatomical variants of the superficial veins of the anterior upper limb (SVASUL), differing in prominence, connectivity, symmetry, and morphology. Among 75 upper limbs, 87% were asymmetrical. Well-developed veins were observed in 60% of cases, with the most common variant (24%) showing all major veins prominent, whereas in 40% the veins were poorly developed or absent. Specific patterns included a well-developed median cubital vein (10%), well-developed lateral and medial superficial veins of the arm (14%), and combinations with the median forearm vein (6%). The prominence and continuity of venous anastomoses were classified into continuous networks (77%) with large anastomosing veins, and discontinuous networks (23%) linked by smaller veins and microcirculatory vessels. Venous anastomoses were further classified by shape, with the V-shaped type being the most frequent (29%), followed by N-, M-, H-, W-, U-, Y-, O-, X-shaped, network-like forms, and mixed types. This classification provides a comprehensive framework for describing SVASUL variability, which has clinical relevance for venous access procedures and surgical interventions. Conclusions SVASUL are characterized by bilateral asymmetry in 87% of cases, continuous venous networks in 77% of cases, and well-developed veins in 60% of cases. Among the well-developed veins, the most common variant includes prominent lateral and medial superficial veins of the arm together with the median cubital vein (24% of cases), while the most frequent shape of the venous anastomosis is the V-shaped type (29% of cases).