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CASE REPORT
Year : 2005  |  Volume : 38  |  Issue : 2  |  Page : 147-149
 

Arterial variations of upper limb: a case report


Department of Anatomy, Melaka Manipal Medical College (Manipal Campus), ICHS, Manipal, Karnataka-576 104, India

Correspondence Address:
V R Vollala
Department of Anatomy, Melaka Manipal Medical College (Manipal Campus), International Centre for Health Sciences, Manipal-576104, Karnataka State
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-0358.19785

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 » Abstract 

Variations of upper limb arteries are common and there are many reports about this subject. We report multiple variations in arterial pattern of upper extremity, which were encountered in a single cadaver.



How to cite this article:
Vollala V R, Rao M, Prasad D. Arterial variations of upper limb: a case report. Indian J Plast Surg 2005;38:147-9


How to cite this URL:
Vollala V R, Rao M, Prasad D. Arterial variations of upper limb: a case report. Indian J Plast Surg [serial online] 2005 [cited 2019 Apr 20];38:147-9. Available from: http://www.ijps.org/text.asp?2005/38/2/147/19785



 » Case history Top


During the dissection classes in the Department of Anatomy at Melaka Manipal Medical College, a 50-year-old female cadaver showed multiple

variations in arterial pattern of both the upper extremities. Some of these variations are well documented, but not collectively in a single subject. The findings included

1. Presence of an anastomotic artery, which connected brachial artery to the radial artery [Figure - 1].

2. Radial artery passed deep to the tendon of biceps brachii in the cubital fossa [Figure - 2]

3. Median artery arose directly from ulnar artery and pierced the median nerve

4. Formation of superficial palmar arch by superficial branch of ulnar artery and the median artery [Figure - 3].


 » Discussion Top


The anomalies of upper limb arteries are common and there are reports of presence of vasa aberrantia, variations of radial artery, median artery and superficial palmar arch, which are described in standard textbooks[1], [2] and in recent papers.[3], [4], [5], [6],[7]

In the present case, the anastomotic artery (vasa aberrantia) arose from the brachial artery and coursed between the median and musculocutaneous nerves in the arm, passed to the forearm under the bicipital aponeurosis and connected to the radial artery after the latter passed deep to the tendon of biceps brachii. Diagnostically, the vasa aberrantia may disturb the evaluation of angiographic images. Interventionally, accidental puncture of superficially placed arteries may occur while attempting venipuncture. Surgically, it is vulnerable in both orthopaedic and plastic surgery operations. Due to the anomalous course, the radial artery may be compressed; in which case, the communicating artery may compensate the blood flow to the forearm. Recently, the radial artery approach for diagnostic cardiac catheterization and interventional procedures has become popular. However, its utility in the present case would be limited since the artery passed deep to the tendon of biceps brachii. It has been reported that, the anatomic variations of the artery such as the radial loop pattern that is encountered close to its junction with brachial artery may render the cardiac catheterization method not feasible.[8]

The persistent median artery may cause carpal tunnel syndrome and may cause damage to the median nerve in two different ways: compression and ischaemia.[5] The persistent median artery piercing the median nerve may be clinically important because symptoms of median nerve compression arising from similar variations are often confused with more common causes such as radiculopathy and carpal tunnel syndrome.

The source for both the vessels, which are forming the superficial palmar arch in the present case, is the ulnar artery proper. In case of bleeding from the palm, if the ulnar artery is ligated at its origin close to the bifurcation of brachial artery, the blood flow in this arch via both these routes gets completely cut off. Then the only source of blood supply is via the radial artery, deep palmar arch and then through perforating arteries indicating their importance. The radial artery is being used for transplant surgery in cases of coronary artery disease. So, one should be careful under such circumstances that if the radial artery is removed then the ulnar artery cannot be ligated as then the blood supply to hand will be totally jeopardized.[7]

In a recently reported clinical case, the absence of the ulnar artery was responsible for hand ischaemia after radial artery grafting for coronary bypass.[9]

The number and the form of these variations in a single cadaver have not been reported previously and our observations may be of interest to surgeons and anatomists. 


 

 » References Top

1.Bergman RA, Thompson SA, Afifi AK, Saadeh FA. Compendium of human anatomic variations. Urban & Schwarzenberg. Baltimore- Munich.1988.  Back to cited text no. 1    
2.Williams P. Gray's Anatomy, 38th edn. Churchil & Livingstone, Baltimore; 1995.  Back to cited text no. 2    
3.Uzun A, Seelig LL Jr. The anastomotic artery connecting the axillary or brachial artery to one of the forearm arteries. Folia Morphol 2000;59:217-20.  Back to cited text no. 3    
4.John Gourassas, Usama Albedd, Christodoulos E . Papadopoulos, Georgios Louridas Anomalous origin of Right Radial Artery as a cause of Radial approach Failure of Coronary Angiography. Hellenic J Cardiol 2003;44:226-29.  Back to cited text no. 4    
5.Galassi E, Benfenati A, Tognetti F, Pozzati E. Persistence of median artery: possible cause of carpal tunnel syndrome. Riv Neurol 1980;50:159-66.  Back to cited text no. 5    
6.Porter CJW, Mellow CG. Anatomically aberrant forearm arteries: an absent radial artery with co-dominant median and ulnar arteries. Br J Plast Surg 2001;54:727-8.  Back to cited text no. 6    
7.Patnaik VVG, Kalsey G, Singla Rajan K. Palmar arterial arches-A morphological study. J Anat Soc India 2002;51:187-93.  Back to cited text no. 7    
8.Louvard Y, Lefevre T. Loops and transradial approach in coronary diagnosis and intervention. Catheter Cardiovasc Interv 2000;51:250-2.  Back to cited text no. 8    
9.Nunoo-Mensah J. An Unexpected complication after harvesting of the radial artery for coronary artery bypass grafting. Ann Thoracic Surg 1998;66:929-31.  Back to cited text no. 9    

 

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