Page 26 - Virtual Vascular Volume 7

Radiocephalic AV fistula creation

at the anatomical snuffbox

The anatomical snuffbox (also known as the radial fossa), is a triangular Longitudinal incision was

depression found on the lateral aspect of the dorsum of the hand. It is made at anatomical snuffbox
located at the level of the carpal bones, and best seen when the thumb is with cephalic vein exposed

extended.

Borders

As the snuffbox is triangularly shaped, it has three borders, a floor, and a

roof
- Ulnar (medial) border: Tendon of the extensor pollicis longus.

- Radial (lateral) border: Tendons of the extensor pollicis brevis and

abductor pollicis longus.
- Proximal border: Styloid process of the radius

- Floor: Carpal bones; scaphoid and trapezium
- Roof: Skin.

Contents Cephalic Vein
The main contents of the anatomical snuffbox are the radial artery, a

branch of the radial nerve, and the cephalic vein:

- Radial artery : crosses the floor of the anatomical snuffbox, then turns
medially and travels between the heads of the adductor pollicis muscle. Radial artery

The radial pulse can be palpated in some individuals by placing two fingers
on the proximal portion of the anatomical snuffbox.

- Superficial branch of the radial nerve: found in the skin and

subcutaneous tissue of the anatomical snuffbox. It innervates the dorsal
surface of the lateral three and half digits, and the associated area on the

back of the hand.

- Cephalic vein – arises from the dorsal venous network of the hand
and crosses the anatomical snuffbox to travel up the anterolateral aspect

of the forearm.

Due to its accessible nature and proximity of vessels this is the first choice
for creating arteriovenous fistula for dialysis access.

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