© Springer Science+Business Media VACTERL (Upper Extremity Limb Abnormalities) This photo shows radial atresia of the right arm in a patient with VACTERL (v ertebral anomalies, a nal atresia, c ardiac malformations, t racheo e sophageal fistula, r enal anomalies and r adial aplasia, and l imb anomalies) syndrome.