Artery In Cubital Fossa Research Articles

Elevated ramification of arterial brachialis and its quantifiable impact

Introduction: Knowledge of variations play significant role in medical sciences and surgical outcome. Discrepancy of arterial Brachialis should be known and kept in mind of radiologists, surgeons during surgical procedures, reconstructive surgeries, measuring blood pressure. So to prevent any accidental detriment, cognizance and scrutiny of anatomical variation is very important. Materials and Methods: Prevalent engagement was carried out on 12 upper limbs of 6 cadavers, during dissection in Branch of Anatomy, AIIMS Rishikesh, independent of age and sex. All dissections was done as per Cunningham handy guidebook of Anatomy, during dissection for undergraduate students. Variations were observed and noted. Observation and Result: Arm length varied from 29 to 35 cm on right or left side. Branching pattern was uniform in (100 per cent cases) of left arm, arterial Brachialis was splitted in Radial and Ulnar artery in cubital fossa. But in right limb 4 (66.70 per cent) constrains of divarication was in cubital-fossa, 1(16.70 per cent) in middle third arm and 1 (16.70 per cent) cases in upper third arm directed to the acromian process. Conclusion: We noted that disparity in arterial brachialis is frequent. There is no compelling association between arm- magnitude and the level of Arterial brachialis partition. Association of Anatomical disparity in branching outline of arterial Brachialis is vital to avert unintended injury to blood vessel during any interventional clinical procedure. Keywords: Arterial brachialis, Cubital fossa, Bifurcation, Arm, Cadaver.

Variant origin of Common Interosseous Artery from Brachial Artery

Acharya Sushruta has emphasized the method and importance of dissection to study anatomy practically. Perfect knowledge of anatomy is vital for practicing surgeons and hence the training of dissecting the dead body was considered as mandatory for surgeons. Though dissection techniques may give the perception of the structure of organs, the pervading and subtle consciousness in the body can be experienced with the eyes of knowledge and penance only. Though the standard anatomy is defined based on statistical inferences on comparing large number of subjects, individual variations and exceptional structural specialties tend to occur quite frequently. Proper recording and publication of such instances would strengthen the knowledge base of the science. Knowledge regarding arterial variations of upper limb is important for surgeons and orthopedicians as they are commonly involved in invasive procedures. We report a case ofvariant origin of right common interosseous artery from brachial artery in cubital fossa. It followed a normal course after the origin.

Accidental Intra-arterial Cannulation: an Unusual Case.

Dear editor, Mrs X, 21 years old G3P2 with premature rupture of membranes at 41 weeks gestation, had intravenous cannulation in cubital fossa for oxytocin augmentation. Oxytocin infusion was continued for 10 h. Thereafter, she was given intravenous injections of ampicillin and gentamicin. Immediately after injection, oedema of the forearm was noted which was thought to be due to extravasation of drug. Cannula was immediately removed, and magnesium sulphate ointment was applied locally. After 4 h, massive oedema and cyanosis were noticed in the forearm and hand distal to the cannula with absent radial pulsations, leading to a provisional diagnosis of brachial artery thrombosis. Urgent vascular surgeon consultation was obtained. By this time, cervix was fully dilated and patient delivered vaginally a 3-Kg baby, following which thromboembolectomy was done. Post thromboembolectomy, ultrasound Doppler revealed short segmental thrombus of the right brachial artery in distal one-third of arm; ulnar artery patent for only a segment of 3 cm from its origin and radial artery and veins patent throughout. Postoperative care included broad spectrum antibiotics, vasodilators, anticoagulants, limb elevation and dressings. Blisters were noticed over the dorsum of hand on postnatal day 2; diagnosis of compartment syndrome was made for which fasciotomy was done. Repeated ultrasound Doppler after 2 months revealed occlusion of short segment of right brachial artery in cubital fossa, occlusion of right ulnar artery in forearm with multiple collaterals in forearm. Patient had complete resolution of sequelae with complete functioning of hand in 3 months. Accidental intra-arterial anaesthetic drug injections have been reported previously [1]. It has been proposed that lipid soluble drugs are more problematic, and brachial artery is associated with more tissue damage than radial or ulnar [1]. The immediate clinical presentations include pain, pallor in hand and cyanosis of fingers followed by extensive oedema of hand and forearm within 5 h. Extensive injury includes nerve damage, compartment syndrome, thrombosis and gangrene leading to eventual amputation [2]. In this case, significant time elapsed before arterial catheterisation was discovered resulting in disastrous outcome. In summary, vigilance is the best therapy. An indwelling catheter not functioning properly should never simply be assumed to be positional. Alarming signs include marked increase in blood pressure on flushing the line, bright red appearance of blood, more intense pain than expected, distal signs of ischaemia, manual palpation of arterial pulse proximal to the catheter and retrograde pulsatile blood flow. Diagnosis is by pressure transducer or blood gas analysis. Treatment recommendations include continuous heparin infusion for 24 h which, if done immediately, leads to no sequelae; sympathetic blockage with brachial plexus block, stellate ganglion block and general anaesthesia for further sympatholysis, postoperative limb elevation and maintenance of warmth, intra-arterial vasodilators and surgical exploration to extract thrombus and fasciotomy [2]. To conclude, a high index of suspicion of intra-arterial cannulation can prevent disastrous consequences. It is recommended that if suspicion is high, intravenous catheterisation should be repeated unless situation is extremely dire and no other intravenous access is readily obtainable.