JuniperPublishers- Variation in Bifurcation of Brachial Artery: A Case Report

Journal of Surgery- JuniperPublishers



Abstract

Brachial artery, the main artery of the arm, usually distributes at the level of neck of radius into two branches. This article reports a case of high division of the brachial artery at the level of insertion of the coraco brachialis muscle. This variation, though not very rare, occurs in the embryo due to permanence of the upper portion of the radial artery rising from the brachial artery proximal to the origin of the ulnar artery followed by failure of development of the new connector of the radial artery with the brachial artery at the level of origin of the ulnar artery. High division of the brachial artery has a deep applied importance especially in the field of vascular surgery and radiology, and the feasibility of this variation should be bore in mind before any vascular surgery in the region of the forearm or while interpreting arterio grams of the upper limb.
Keywords: Brachial artery; Variation; Radial artery; Ulnar artery

Introduction

The brachial artery is the main artery of the arm and continuation of the axillary artery. Its proximal boundary is at the level of the inferior border of the teres major muscle and its distal boundary is at approximately a centimeter distal to the elbow joint at the level of the radial head. Passing below the bicipital aponeurosis, the brachial artery divides into the radial and ulnar arteries [1]. The artery is wholly superficial, covered anteriorly by skin and fascia and crossed superficially by the median nerve from the lateral to the medial side [2]. The brachial artery gives origin to profunda brachii, nutrient, superior and inferior ulnar collateral and muscular [3]. Variations in the arterial supply of the upper limb are relatively usual, with reported frequencies of incidence ranging from 11 to 24.4%. They can be found at different situations along the axillary, brachial, radial, or ulnar arteries, as well as in the palmar arches [4]. The recognition and documentation of expansion variation in the course, distribution and branching pattern of the arteries of upper limb is highly considerable in the angiographic and surgical practice [5]. In the present case, a rare variation of brachial artery apportions into radial and an ulnar artery in middle third of arm with superficial course of radial artery in right forearm is presented.

Case Report

During anatomical dissection of the left upper limb of a male Iranian cadaver in the Medical Faculty of Tehran University of Medical Sciences, an anatomical variation of the high region brachial artery was recognized. The skin and fascia of the left upper limb was completely dissected, and the neurovascular bundles of the axillae and the whole limb was clearly explored. The course of the arteries and their branches were thoroughly traced and the observed anatomical variation was recorded. The axillary artery in left upper limb had normal anatomical course and branching pattern with the branches of brachial plexus cords normally distributed around it. The radial artery arose at the level of insertion of the coraco brachialis muscle. The brachial artery continued as ulnar artery in the forearm. Further course and branching of the radial and ulnar arteries in the forearm and palm was usual (Figure 1).

Discussion

In the upper limb sprout, the axis artery is derived from the lateral branch of the seventh intersegmental artery that is subclavian artery [6]. The proximal part of the main trunk of this artery forms axillary and brachial arteries and its distal part continues as anterior interosseous artery and deep palmer arch(6). Radial and ulnar arteries are last to become evident in the forearm from the axis artery, that is brachial artery. Initially, the radial artery arises more proximally than the ulnar artery. Then, it establishes a new connection with the main trunk at or near the level of the ulnar artery. The upper portion of its original stalk usually disappears to a large extent. To date, the reasons for the various prevalence rates of arterial variations in different geographical regions are not well understood.

Conclusion

Diagnostically, this variation may disturb the assessment of arteriography images and can have serious implications in orthopedic and vascular surgeries. Also, variations in the arterial of this region may be encountered during arteriography test, percutaneous brachial catheterization, and skin flap elevations from the arm or forearm [7-11]. Blood pressure, which is regularly measured in the arm in the brachial artery, is also influence when there are double arteries instead of a single brachial artery. On the other hand, accidental intraarterial injections into the brachial artery may lead to ample bleeding, thrombosis, and loss of the upper limb [8,12]. Finally, being superficial, the brachial artery can be mistaken for a vein and accidental injection of drugs in this artery may cause reflex vascular obstruction resulting in disastrous gangrene of hand.

To read more articles in Journal of Surgery 

Comments

Post a Comment

Popular posts from this blog

Juniper Publishers| The Anatomical Architecture of the Junction between the Great Cerebral Vein and the Straight Sinus in Correlation to the Physiological and Biochemical Impact on Multiple Sclerosis Subtypes and Disease Progression- A Review Article

Image
  Journal of Surgery -  JuniperPublishers Abstract Introduction:  Multiple Sclerosis (MS) is a debilitating autoimmune disorder, characterized by damage to the white matter of the central nervous system. Studies suggest a relationship between impaired cerebral venous blood flow and progressive destruction of white matter in the CNS. Altered cerebral venous architecture is a possible mechanism that may contribute to a compromised venous blood flow pattern in MS patients. Natural variations at junction located between the great cerebral vein (GCV) and the straight sinus (Ss) located within the cerebral venous drainage system can potentially exacerbate MS progression. Recent data indicates that abnormal cerebral venous hemodynamics contributes to the pathophysiology observed in MS through an unknown mechanism that increases hydraulic resistance. Objective:  This review aims to investigate if anatomical variations at the GSV and Ss junction elicit a profound effect on the cerebral venous s
Read more

Juniper Publishers| The Use of the Second-Generation Protein Kinase Inhibitors in Patients with Gastrointestinal Stromal Tumor with Failure to the Treatment with Imatinib

  Journal of Surgery -  JuniperPublishers Introduction:  Gastrointestinal Stromal Tumor (GIST) is considered the most common mesenchymal tumor of the gastrointestinal tract. Approximately 85% of GISTs have mutations in proto-oncogene KIT encoding, a tyrosine kinase receptor. About 8% of GISTs are associated to mutations in the growth factor receptor alpha (PDGFRA) gene. The standard treatment of GIST is the surgical resection of the tumor. In cases of metastasis and tumor recurrence specific drugs as tyrosine kinase inhibitors are used. The first line treatment is Imatinib. Although the treatment with imatinib failed in some patients for the metastatic and relapsed treatment of GIST, the patients can to use other drugs, called second generation. Discussion:  One of the great advances in the diagnosis of GIST was the recognition through the immunohistochemistry of the c-Kit marker. The tyrosine kinase inhibitor, imatinib, has become the standard treatment for those, with high-risk resec
Read more