Rare combined variations of the axillary artery: superficial ulnar artery and circumflex humeral arteries.

Anatomical variations in the branching pattern of the axillary artery are common and typically include the lateral thoracic, subscapular, and the posterior circumflex humeral (PCHA) arteries. Previous investigations of single specimen dissections demonstrate numerous variations to axillary artery branching, but the frequency of these occurrences is unclear. This study quantifies the frequency of variant branching of the lateral thoracic, subscapular, and posterior circumflex humeral arteries, how it they relate to the posterior cord of the brachial plexus. Axillae of 83 cadavers were dissected to allow examination of the axillary artery and its branches. Data were collected observing the branching pattern of the lateral thoracic, subscapular, and posterior circumflex humeral arteries, as well as those branches spatial relationship to the two terminal branches of the posterior cord of the brachial plexus. Some of the more common variations included the thoracodorsal artery arising from the lateral thoracic artery (LTA) (7.2%) and the subscapular artery (SSA) arising from the LTA (5.4%). The SSA also produced the LTA (4.2%) and the PCHA (12%). The PCHA also originated from the deep brachial artery (8.4%) and traversed the triangular interval to supply the deltoid muscle. These findings are relevant to both the anatomical and clinical fields as provide evidence as to the frequency of variant axillary artery branching and the potential for neurovascular elements to exist in a location other than their classical anatomical description.

Background: Axillary artery continues directly from subclavian artery. It usually provides six branches in three parts. Superior thoracic artery is provided by first part of axillary artery whereas the second part provides thoracoacromial artery (TAC) and lateral thoracic artery (LT) and third part provides posterior circumflex humeral artery (PCH), anterior circumflex humeral artery (ACH) and subscapular artery (SS). This branching pattern of axillary artery usually involves anatomical variation and typically inofvolves posterior circumflex humeral artery, lateral thoracic artery and subscapular artery. The variation in this pattern contains surgical and clinical as well as anatomical relevance given the accessibility towards humerus and shoulder joint. Methodology: This study (bilateral axilla dissection) was performed on 28 preserved axillae (14 dead bodies) to permit axillary artery’s examination and its parts. The study was conducted in anatomy department, Services Institute of Medical Sciences, Lahore, from November 2022 to April 2023. Results: 76% of cases showed the characteristic branching pattern of the LT, which originates from the axillary artery posterior to the pectoralis minor muscle, and the SS, which produces the thoracodorsal (TD) and circumflex scapular (CS) arteries. 8% of the time, it was noticed that the SS originated from the LT. Six percent of the time, the LT was seen to be coming from the SS. In the absence of SS, the LT was seen to produce the TD and circumflex scapular artery 3% of the time. According to 76% of classical descriptions, the PCH developed from four distinct sources, the third portion of the axillary artery. 12% from the SS. from the DB 8% deep brachial artery and the LT 3%. Conclusion: It is rather typical for the axillary artery and its branches to have vascular diversity. As this variation can increase the risk of bleeding during surgery of axilla so it is crucial to consider it seriously. It can also cause difficulty in angiography interpretation after axillary catheterization. Keywords: Anatomy of axilla, axillary artery, variation in axilla and vascular variation, lateral thoracic artery (LT), subscapular artery (SS), posterior circumflex humeral artery (PCH).

In an 87-year-old male cadaver received through the Gift Body Program at Saint Louis University School of Medicine, a common arterial trunk arose from the third part of the left axillary artery (AA) that divided into the subscapular artery (SA) and a common stem for the deep brachial artery (DBA), the anterior humeral circumflex artery (AHCA), and the posterior humeral circumflex artery (PHCA). Both the SA and AHCA appeared normal. The PHCA traveled through the quadrangular space and gave off the radial collateral artery (RCA) in the posterior arm which anastomosed with the radial recurrent artery. The DBA traveled through the triangular interval and continued as the middle collateral artery (MCA) in the posterior arm to anastomose with the interosseous recurrent artery. Lastly, the medial and lateral cord contributions to the median nerve formed posteriorly to the AA. Knowing anatomical variation of the AA has clinical and embryological significance.

Knowledge of a large communication between posterior circumflex humeral and deep brachial arteries, although infrequent, it is important to avoid damage during a Leechavengvongs procedure or used as recipient artery in free flaps for upper limb reconstruction. A dissection of a latex-injected cadaver revealed the presence of a large communication between the posterior circumflex humeral and deep brachial arteries. Furthermore, this communicating artery was observed during a Leechavengvongs procedure. A comprehensive review of the existing literature on the anatomical variations of the posterior circumflex humeral and deep brachial arteries was conducted. A communicating artery between the posterior circumflex humeral and deep brachial arteries was identified during a routine dissection. This communicating artery establishes a posterior collateral pathway of substantial caliber between the axillary and the brachial arteries. Given its oblique trajectory posteriorly along the humeral shaft, this artery is susceptible to injury during a posterior approach to the humerus. Despite the existence of numerous anatomical variations involving the posterior circumflex humeral and deep brachial arteries, this communicating artery has not been previously described in the literature. Additionally, we report this anatomical variation crossing the surgical field during a Leechavengvongs procedure. Our findings suggest that a large communicating artery between the posterior circumflex humeral artery and the deep brachial artery has the potential to cross the surgical field and become a source of risk during a posterior approach to the arm. It can also be used as recipient artery in free flaps for upper limb reconstruction.

During routine dissections in the Dept. Of anatomy, Sri Venkateswara Medical college, Tirupathi, A.P. we encountered a rare anomaly in an adult male cadaver on the right upper limb. The third part of the axillary artery unilaterally divides into two major arterial stems, named according to their localization as deep brachial artery and superficial brachial artery (brachial artery proper).Deep brachial artery passes at first in between the two roots of median nerve, and later deep to lateral root of median nerve. The deep brachial artery gives off the posterior circumflex humeral artery, anterior circumflex humeral artery, subscapular artery, and profunda brachii artery and lower down in the arm,it terminates by dividing into superior ulnar collateral artery and inferior ulnar collateral artery. This case is a anamoly of the axillary artery that has been rarely documented in the literature(0.12-3.2%). Accurate knowledge of the normal and variant arterial anatomy of the axillary artery is important for surgeons and specialists using radiodiagnostic techniques. The improved knowledge would allow more accurate diagnostic interpretations and surgical treatment.

ObjectivesTo determine the prevalence of posterior circumflex humeral artery (PCHA) aneurysms and vessel characteristics of the PCHA and deep brachial artery (DBA) in elite volleyball players.MethodsTwo-hundred and eighty players underwent standardized ultrasound assessment of the dominant arm by a vascular technologist. Assessment included determination of PCHA aneurysms (defined as segmental vessel dilatation ≥150 %), PCHA and DBA anatomy, branching pattern, vessel course and diameter.ResultsThe PCHA and DBA were identified in 100 % and 93 % (260/280) of cases, respectively. The prevalence of PCHA aneurysms was 4.6 % (13/280). All aneurysms were detected in proximal PCHA originating from the axillary artery (AA). The PCHA originated from the AA in 81 % of cases (228/280), and showed a curved course dorsally towards the humeral head in 93 % (211/228). The DBA originated from the AA in 73 % of cases (190/260), and showed a straight course parallel to the AA in 93 % (177/190).ConclusionsPCHA aneurysm prevalence in elite volleyball players is high and associated with a specific branching type: a PCHA that originates from the axillary artery. Radiologists should have a high index of suspicion for this vascular overuse injury. For the first time vessel characteristics and reference values are described to facilitate ultrasound assessment.Key Points• Prevalence of PCHA aneurysms is 4.6 % among elite volleyball players.• All aneurysms are in proximal PCHA that originates directly from AA.• Vessel characteristics and reference values are described to facilitate US assessment.• Mean PCHA and DBA diameters can be used as reference values.• Radiologists need a high index of suspicion for this vascular overuse injury.

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.

The third part of the axillary artery unilaterally divides into two major arterial stems, named according to their localization as deep brachial artery and superficial brachial artery (brachial artery). The deep brachial artery gives off the posterior circumflex humeral artery, anterior circumflex humeral artery, subscapular artery, and profunda brachii artery. It continues its course in the arm lateral to the median nerve and terminates by giving a minute twig to the radial artery. The superficial brachial artery is larger in caliber than the deep brachial artery and gives no branches in the arm region. In the cubital fossa it gives the ulnar and the radial arteries. This case is a variant of the axillary artery that has been rarely (0.12-3.2%) documented in the literature. Accurate knowledge of the normal and variant arterial anatomy of the axillary artery is important for clinical procedures in this region. Clin. Anat. 13: 66-68, 2000.

Background: Arterial variations in the upper limb, although infrequent, carry critical clinical implications. The presence of superficial ulnar and radial arteries, especially when originating from high levels, increases the risk of iatrogenic injury, misdiagnosis, and surgical complications. To confirm and describe, through ultrasound and anatomical dissection, the presence of a high-origin superficial ulnar artery and a superficial radial artery in a cadaver, highlighting their anatomical trajectory and clinical relevance. Methods: A cross-sectional ultrasound and anatomical study was conducted on 150 upper limbs from fresh-frozen cadavers. High-frequency ultrasound was used to scan the vasculature from the axilla to the wrist. Subsequently, dissection was performed to confirm sonographic findings. Results: One case (0.66%) of concurrent superficial ulnar artery and superficial radial artery was identified in the left arm of a 79-year-old male cadaver. The superficial ulnar artery originated from the axillary artery and coursed superficially along the forearm, anterior to the flexor muscles. The superficial radial artery emerged from the brachial artery and ran subcutaneously in the distal forearm. These arteries remained in close relation to key neural and venous structures, increasing their vulnerability to clinical error. Conclusions: The identification of high-origin superficial arteries is essential for clinical practice. Ultrasound serves as a reliable, non-invasive method for detecting such variations preoperatively. Awareness of these anomalies can prevent inadvertent vascular injuries, improve diagnostic accuracy, and inform safer surgical and anesthetic approaches in upper limb interventions.

The third part of the axillary artery has three branches: subscapular artery, anterior circumflex humeral artery and posterior circumflex humeral artery. Variations in the branching pattern of the axillary artery are quite common. Knowledge of such variation can avoid injuries during invasive procedures in the axillary region. The present study was carried out on an adult embalmed corpse in the department of Rachana Sharira of the AMC, Nagarur, India. The left axilla was dissected, an anatomical variation in the branching pattern of the Axillary artery was noted, and photographs were taken. The 3rd part of the Axillary Artery gives off the Anterior circumflex humeral artery separately, which is a typical observation. The Posterior circumflex humeral artery and subscapular artery did not have distinct origins from the 3rd part of the axillary artery. In addition to the Anterior circumflex humeral artery, the AA artery also gave a large common trunk from which the Posterior circumflex humeral artery and subscapular artery arose

Variations in the Subscapular Artery (SA) are among the most common variations in the Axillary Artery (AA) and its branches. However, the occurrence of a common trunk from the third division is unusual. Hereby, authors report an atypical variation in the distal division of the axillary artery found during routine dissection of an elderly female cadaver. In this donor, the third portion of the AA gave rise to an SA, a common trunk, and the anterior circumflex humeral artery. In addition, the common trunk gave rise to a second SA, the posterior circumflex humeral artery, the scapular circumflex artery, and the thoracodorsal artery. Both SA branches appeared to irrigate the subscapularis muscles. Comprehension of the diverse anatomical variations of the subscapular artery is critically important in surgical procedures and therapeutic interventions for the upper limb.

Background: The axillary artery is a direct continuation of the subclavian artery. The axillary artery is usually described as giving off six branches. The first part gives superior thoracic artery. The second part gives lateral thoracic (LT) and thoracoacromial(TAC) arteries. The third part gives three, subscapular(SS), anterior circumflex humeral(ACH)and posterior circumflex humeral(PCH) arteries. Anatomical variations in the branching pattern of axillary artery are quiet common and typically include the subscapular artery(SS), lateral thoracic artery(LT) and the posterior circumflex humeral artery(PCH). The variation of the axillary artery branching pattern has anatomical as well as clinical and surgical relevance given the proximity to the shoulder joint and humerus.Patients & Method: Bilateral axilla dissection was conducted on 26 embalmed axillae (13 cadavers) to allow examination of the axillary artery and its branches. The study was carried out in Department of Human Anatomy, College of Medicine.Results: The classical branching pattern of the LT originating from the axillary artery posterior to the pectoralis minor muscle and the SS producing the circumflex scapular (CS) artery and thoracodorsal(TD) occurred in 77%. The SS was observed originating from the LT 7% of the time. The LT was observed originating from the SS 5% of the time. The LT was observed producing the circumflex scapular artery and TD in the absence of SS 2.5% of the time. The PCH originated from four different sources, from the third part of axillary artery as is classically described in 77%. From the SS 11%. From deep brachial artery DB 9% and from LT 2%.Conclusion: Vascular variation in the axillary artery and its branches is quiet common , This variation should be considered seriously as will implicate risk of bleeding during surgery in the axilla and also the difficulty in interpretation of the angiography after axillary catheterization.

ObjectivesElite overhead athletes are at risk of posterior circumflex humeral artery (PCHA) degeneration, aneurysm formation and thrombosis. Identification of the proximal PCHA and the nearby originating deep brachial artery (DBA) can be a challenge, even among experienced sonographers. The aim of this study was to assess the accuracy and precision of a newly designed standardized ultrasound (US) protocol (SPI-US) for assessment of the PCHA and DBA.MethodsTwo experienced sonographers determined diameters of the PCHA and DBA using the SPI-US protocol. Inter-observer agreement was evaluated using intra-class correlation coefficient (ICC), standard error of measurement (SEM), minimal detectable change (MDC), Bland-Altman (BA) analysis, and variance component (VARCOMP) analysis.ResultsThirty-three healthy volunteers participated. The ICC for diameter measurement of the PCHA and DBA were 0.70 (95 %CI 0.50-0.83) and 0.60 (95 %CI 0.30-0.80), respectively. The SEM for the PCHA and DBA was 0.32 mm and 0.29 mm and MDC was 0.90 mm and 0.80 mm, respectively. The BA and VARCOMP analyses showed no systematic and only marginal sonographer bias.ConclusionsThe SPI-US protocol is accurate and precise for PCHA and DBA diameter assessment in cases where they originate from the axillary artery. PCHA and DBA diameter measurements are sonographer-independent using the SPI-US-protocol.Key points• PCHA & DBA diameter assessment is accurate and reliable using the SPI-US protocol• PCHA & DBA diameter measurements are sonographer-independent using the SPI-US protocol• The SPI-US protocol minimal detectable change is 0.90 mm for PCHA diameter measurement• This minimal detectable change enables detection of PCHA aneurysms• First step towards international periodic surveillance of athletes at risk of PCHA-injury

The current consensus in the literature is that the anterolateral branch of the anterior humeral circumflex artery provides the main blood supply to the humeral head. While the artery is disrupted in association with 80% of proximal humeral fractures, resultant osteonecrosis is infrequent. This inconsistency suggests a greater role for the posterior humeral circumflex artery than has been previously described. We hypothesized that the posterior humeral circumflex artery provides a greater percentage of perfusion to the humeral head than the anterior humeral circumflex artery does. In twenty-four fresh-frozen cadaver shoulders (twelve matched pairs), we cannulated the axillary artery proximal to the thoracoacromial branch and ligated the brachial artery in the forearm. In each pair, one shoulder served as a control with intact vasculature and, in the contralateral shoulder, either the anterior humeral circumflex artery or the posterior humeral circumflex artery was ligated. Gadolinium was injected through the cannulated axillary arteries, and magnetic resonance imaging was performed. After imaging, a urethane polymer was injected, and specimens were dissected. For volumetric analysis, the gadolinium uptake on the magnetic resonance imaging was quantified in each quadrant of the humeral head with use of a custom automated program. The gadolinium uptake was compared between the control and ligated sides and between the ligated anterior humeral circumflex artery and ligated posterior humeral circumflex artery groups. The posterior humeral circumflex artery provided 64% of the blood supply to the humeral head overall, whereas the anterior humeral circumflex artery supplied 36%. The posterior humeral circumflex artery also provided significantly more of the blood supply in three of the four quadrants of the humeral head. The finding that the posterior humeral circumflex artery provides 64% of the blood supply to the humeral head provides a possible explanation for the relatively low rates of osteonecrosis seen in association with displaced fractures of the proximal part of the humerus. In addition, protecting the posterior humeral circumflex artery during the surgical approach and fracture fixation may minimize loss of the blood supply to the humeral head.

The Axillary artery is the continuation of the subclavian artery and is a major artery of the upper limb. During the routine dissection for Undergraduate Ayurvedic Medical Students of Sharada Ayurvedic Medical College, Yadgir, Karnataka, India, in the Department of Anatomy, we come across a variation in branching pattern of second and third part of right axillary artery in male cadaver approximately 55 years of age. The first part of axillary artery was found to be normal. In the second part of axillary artery we observed two branches, first one is thoracoacromial artery arose as usual second branch given common trunk which is further divided into lateral thoracic artery and subscapular artery. Even third part of axillary artery gave one common trunk that terminated by bifurcating into Anterior Circumflex Humeral Artery and Posterior Circumflex Humeral Artery.