A coincidental variation of the axillary artery: the brachioradial artery and the aberrant posterior humeral circumflex artery passing under the tendon of the latissimus dorsi muscle
A case of anomalous terminal branching of the axillary artery was encountered and described in a left upper limb of a male cadaver. A series of 214 upper limbs of Caucasian race was dissected. A variant artery, stemming from the very end of the axillary artery followed a superficial course distally. It passed the cubital fossa, ran on the lateral side of the forearm as usual radial artery, crossed ventrally to the palm and terminated in the deep palmar arch. This vessel is a case of the brachioradial artery (incorrectly termed as the “radial artery with high origin”). Moreover, it was associated with another variation, concerning the aberrant posterior humeral circumflex artery passing under the tendon of the latissimus dorsi muscle. The anatomical knowledge of the axillary region is essential for radiodiagnostic, surgical and traumatologic procedures. The superficially located artery brings an elevated danger of heavy bleeding in all unexpected situations, its variant branching can cause problems in radial catheterization procedures and the anomalously coursing other arterial variant poses an elevated danger in surgical procedures concerning the surgical neck of humerus.
Rodríguez-Niedenführ M, Burton J, Deu J, Sañudo JR. Development of the arterial pattern in the upper limb of staged human embryos: normal development and anatomic variations. J Anat 2001; 199:407-417.
Kachlik D, Konarik M, Baca V. Vascular patterns of upper limb: an anatomical study with accent on superficial brachial artery. Bosn J Basic Med Sci 2011; 11:4-10.
Rodríguez-Niedenführ M, Vázquez T, Nearn L, Ferreira B, Parkin I, Sañudo JR. Variations of the arterial pattern in the upper limb revisited: a morphological and statistical study, with a review of the literature. J Anat 2001; 199:547-566.
FCAT. Terminologia anatomica. Stuttgart: Thieme Verlag; 1998.
Kachlik D, Baca V, Bozdechova I, Cech P, Musil V. Anatomical terminology and nomenclature: Past, Presence and Highlights. Surg Radiol Anat 2008;30:459-466.
Kachlik D, Bozdechova I, Cech P, Musil V, Baca V. Mistakes in the usage of anatomical terminology in clinical practice. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2009; 153:157-162.
Adachi B. Das Arteriensystem der Japaner. Kyoto: Maruzen; 1928; 285-356.
Coulouma P, Bastien P, Garraud R. Sur cinq cas d´ artére cubitale superficielle naissant par bifurcation précoce du tronc axillo-huméral. Echo Méd Nord 1934; 2:613-619.
Skopakoff C. Über die Variabilität Ab- und Verzweigung der A. brachialis superficialis. Anat Anz 1959; 106:356-368.
Keen JA. A study of the arterial variations in the limbs with special reference to symmetry of vascular patterns. Am J Anat 1961; 108:245-261.
Olinger A, Benninger B. Branching patterns of the lateral thoracic, subscapular, and posterior circumflex humeral arteries and their relationship to the posterior cord of the brachial plexus. Clin Anat 2010; 23:407-412.
Golan J, Kaus M, Szwarc P. High origin of the ulnar and radial arteries in human. Folia Morphol (Warsz) 1994; 53:37-48.
Rao PV, Chaudhary SC. Superficial brachial artery terminating as radial and superficial ulnar arteries: a case report. Centr Afr J Med 2001; 47:78-80.
Anatomy Atlases: Illustrated Encyclopedia of Human Anatomic Variation, Opus II, Cardiovascular System, Arteries, Upper Limb, Brachial Artery [Internet]. c1995-2014. [cited 2014-08-22]. Available from: http://www.anatomyatlases.org/AnatomicVariants/Cardiovascular/Text/Arteries/Brachial.shtml.
Kachlik D, Konarik M, Cupka T, Knize J, Baca V. An unusual course of the arteria circumflexa humeri posterior. Surg Radiol Anat 2009; 31:158-159.
Quain R. Anatomy of the arteries of the human body. London: Taylor and Wolton, 1844;326-337.
Müller E. Beiträge zur Morphologie des Gefässsystem. Die Armarterien des Menchen. Anat Hefte 1903;22: 377-575.
McCormack LJ, Cauldwell EW, Anson BJ. Brachial and antebrachial arterial patterns: a study of 750 extremities. Surg Gynecol Obstet 1953; 96:43-45.
Weathersby HT. Anomalies of brachial and antebrachial arteries of surgical significance. South Med J 1956; 49:46-49.
Rodríguez-Baeza A, Nebot J, Ferreira B, Reina F, Pérez J, Sañudo JR, Roig M. An anatomical study and ontogenetic explanation of 23 cases with variations in the main patterns of the human brachio-antebrachial arteries. J Anat 1995; 187:473-479.
Topol EJ, Teirstein PS. Textbook of Interventional Cardiology, 6th ed. Philadeplphia: Elsevier Saunders; 2011.
Singer E. Embryological patterns persisting in the arteries of the arm. Anat Rec 1933; 55: 406-413.
Jurjus AR, Correa-De-Aruaujo R, Bohn RC. Bilateral double axillary artery: embryological basis and clinical implications. Clin Anat 1999; 12:135-140.
Karlsson S, Niechajev IA. Arterial anatomy of the upper extremity. Acta Radiol (Stockholm) 1982; 23: 115-121.
Evans HM. The development of the vascular system. In; Keibe F, Mall FP (eds). Manual of human embryology. Vol. 2. Philadelphia: J.B. Lippincott; 1912; 570-709.
Senior HD. A note on the development of the radial artery. Anat Rec 1926; 33:220-221.
Maraspin LE. A report of an anomalous bifurcation of the right axillary artery in man. Vasc Surg 1971; 5:133-136.
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