An unusual high bifurcation and variable branching of the axillary artery in a Greek male cadaver.

Konstantinos Natsis,Maria Piagkou,Nikitas–Apollon Panagiotopoulos,Stylianos Apostolidis

doi:10.1186/2193-1801-3-640

Abstract

IntroductionThe axillary artery presents abnormalities in its origin and course and a variable branching.Case descriptionA rare case of axillary artery bifurcation and branching was observed in a 60-years-old European male cadaver of Greek origin. The right axillary artery at the second part was bifurcated into a superficial and a deep brachial artery. The superficial brachial artery anteromedial to the median nerve and lateral to the ulnar nerve gave off the acromio-thoracic artery and two lateral thoracic arteries. The deep brachial artery behind the median nerve, after giving rise to the anterior circumflex humeral artery trifurcated into a branch that coursed distally, the posterior circumflex humeral artery and the subscapular artery. The latter subdivided into the circumflex scapular artery, a muscular branch for the subscapularis and the thoracodorsal artery. The continuation of the deep brachial artery divided laterally into a humeral nutrient artery and medially into a trunk which trifurcated into the profunda brachii artery, a deep muscular branch and a branch to the posterior compartment of the arm. The profunda brachii artery ended as radial and middle collateral arteries.Discussion and evaluationDeviations from the normal arterial pattern are of immense significance for anatomists, plastic, cardiovascular and orthopedic surgeons, vascular radiologists and interventional cardiologists.

Highlights

The axillary artery presents abnormalities in its origin and course and a variable branching.Case description: A rare case of axillary artery bifurcation and branching was observed in a 60-years-old European male cadaver of Greek origin
The 1st part gives rise to the superior thoracic artery (STA), the 2nd part surrounded by the cords of the brachial plexus provides the acromiothoracic (ATA) and the lateral thoracic arteries (LTAs) and the 3rd part gives off the subscapular artery (SSA), the anterior and posterior circumflex humeral arteries (ACHA and Posterior circumflex humeral artery (PCHA)) (Adachi 1928)
The arterial variations can be explained as a deviation from the normal vascular pattern (Konarik et al 2009; Singer, 1933) and especially the superficial brachial artery (SBA) presence is based on the persistence of more than one intersegmental cervical artery, which remains and can even increase in size (Jurjus et al 1999)

Summary

Discussion and evaluation

The coexistence of abnormalities of the AA (variable origin, abnormal course and aberrant or variable branches) is unusual, while isolated aberrations of the arterial pattern follow a wide range among races (Yang et al 2008). The DBA after giving off the ACHA trifurcated into the PCHA, the SSA and a branch that continued in the arm. Unlike to Jurjus et al (1999), the DBA was larger than the SBA and the latter bifurcated into radial and ulnar arteries as usual, while in other studies, the SBA ended in the arm or continued as radial (high origin of radial) (Cavdar et al 2000; Keen 1961; Natsis et al 2009; Rodriguez-Niedenfuhr et al 2001). The superficial course of the SBA makes the arterial grafting and cardiac catheterization easier, the high bifurcation of the AA and its abnormal branching pattern may pose problems to clinician during angiographic procedures leading to diagnostic errors. The variable arterial pattern is important to be identified preoperatively using Doppler ultrasound imaging or angiography, especially in emergency cases of chest wall reconstruction such as in Poland’s Syndrome (Shipkov et al 2000) or during breast cancer surgery and axillary lymph nodes dissection, when surgeons have to correctly identify and protect the axillary vessels (Jurjus et al 1999)

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