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Please confirm that an ethics committee approval has been applied for or granted: Yes: I’m uploading the Ethics Committee Approval as a PDF file with this abstract submissionBackground and Aims The persistent median artery (PMA), a remnant accessory vessel in the forearm, travels alongside the median nerve and may alter the nerve’s path. Its prevalence in the South African population is not well-researched. As a significant anatomical variation, it lies close to the median nerve, a common site for regional anaesthesia. This study aimed to determine the prevalence of PMA among patients at a public hospital in Johannesburg.Methods This cross-sectional descriptive study utilised ultrasound imaging to examine the prevalence of PMA. A total of 197 patients (1 to 73 years) presenting at the Chris Hani Baragwanath Academic Hospital Hand Clinic, underwent ultrasound examinations of both forearms following a standardised protocol. The population was predominantly Black (88%) individuals. Logistic regression analysis was performed to identify factors associated with PMA, adjusting for age group, occupation, and reason for visit. The University of the Witwatersrand Health Science Ethics Committee (Medical) granted study approval (R14/49).Results The prevalence of PMA was 27% (n=54). Age was a significant factor, with individuals aged 1–10 years having the highest prevalence (67%, n=8). Older age groups showed significantly lower odds of PMA presence, particularly individuals aged 41–50 years (OR = 0.11, 95% CI: 0.024–0.48, p=0.003) and 51–60 years (OR = 0.11, 95% CI: 0.03–0.45, p=0.002). PMA was present bilaterally in 14% (n=27), on the left in 9% (n=19), and on the right in 4% (n=8).Conclusions The PMA represents a significant variation with clinical implications due to its close association with the median nerve, a frequent target for regional anaesthesia. Recognising PMA during surgical interventions and anaesthetic procedures in the forearm is crucial to mitigate potential complications. Greater awareness of this vessel among anaesthetists and surgeons is vital in improving procedural safety and anatomical accuracy, especially in younger patients.