High Bifurcation Of Brachial Artery Research Articles

Unilateral identification of a rare superficial brachioulnoradial artery contributing to the superficial palmar arch and brachial artery continuing as the interosseous artery: a case report.

The occurrence of variations in human arterial branching of the upper limb has been commonly reported in peer-reviewed literature. However, the variability of upper limb arterial patterns may be underappreciated in medical practice, which can result in clinical and surgical errors. Here we report a case of a rare, unilateral arterial variation of the left upper limb of a 76-year-old Caucasian male cadaver, discovered during a routine educational dissection. Observed characteristics of the variation include a high brachial artery bifurcation into a superficial brachioulnoradial artery and brachial artery continuing as the interosseous artery and then a bifurcation of the superficial brachioulnoradial artery into a superficial radial and a superficial ulnar artery, which eventually contribute to the formation of the superficial palmar arch. The anatomical characteristics, prevalence, embryological origin, and clinical significance of the variation are discussed.

High bifurcation of the unilateral brachial artery: an unusual variation.

It is common to observe a high bifurcation of the brachial artery, with some variations being quite rare. During routine dissection for medical teaching purposes, a unilateral high bifurcation of the brachial artery was noted on the left side of a female cadaver. On the left arm, two branches of different sizes originate from the axillary artery, one on the radial side and the other on the ulnar side. These branches run down the arm, crossing each other, eventually becoming the forearm's radial and ulnar arteries. We also observed branches such as the posterior circumflex humeral artery, anterior circumflex humeral artery, and deep brachial artery. This case report adds to the existing body of knowledge about the variation of the brachial artery, which is of anatomical and clinical value. We report this case to highlight the unique variation in the arterial anatomy of the upper limb.

Anatomical variation of high brachial artery bifurcation: A case report

INTRODUCTION: Anatomical variation of high brachial artery bifurcation and these morphological variations of the brachial artery should be considered by surgeons when performing procedures in the brachial artery area.CASE: The left anterior arm and anterior forearm regions of a thirty-three-year-old cadaver was dissected. The origin, course, and terminal branches of the Brachial artery were traced. It was then observed that the Brachial artery bifurcation was in the upper third of the humerus instead of the cubital fossa. CONCLUSION: Brachial artery and its terminal branch variations are less common. However Brachial artery could be bifurcated and then reunite. In this case, the brachial artery presented bifurcation one laterally and another one medially with the median nerve running between them. Both branches don’t reunite but continue laterally and medially, respectively.

High Brachial Artery Bifurcation Clinical finding in Cadaveric Specimen by Medical Students During Internship

The high brachial artery bifurcation is an anatomical variation found in the arm segment. Although it does not present any alteration in the arterial blood functionality, it is considered a common spot for vascular lesions during surgical interventions that consist of the absence of anatomical knowledge. The research objective was to describe the high brachial artery bifurcation found in a cadaveric specimen from the anatomy laboratory as well as its main anatomoclinical aspects. Twenty-six upper limbs were investigated and dissected from the Universidade Brasil's Human Anatomy Laboratory, SP. These were formolized cadaveric specimens from both sexes. During upper limb dissection, arterial anatomical variations were observed in a single-arm segment. The variation was unilateral in the left hemisphere. The clinical findings were high brachial artery bifurcation and a rare case of the radial artery in the medial path, as well as an ulnar artery with a lateral path in the arm median third. It is clear that the understanding of anatomy and anatomical variations patterns is of utmost importance and a requirement for surgery, so surgeons need to be aware of clinical, anatomical, and arterial variations data, avoiding vascular lesions during the surgical interventions. Dissection is an important learning tool for students and resident doctors. It is suggested the use of dissection as a pedagogical resource to acquire skills in surgeries during internship and also to improve the anatomical variation cognition of upper limbs.

Anatomical variations of the terminal branching of the brachial artery

ObjectiveKnowledge regarding arterial variations is important during surgeries, intra-arterial injections, venipuncture and imaging of the upper limb. Our objective was to document brachial artery variations. MethodsWe studied 54 upper limb specimens during routine dissection. The anterior compartment of the arm, cubital fossa and the forearm were dissected and the pathway and the distribution of the brachial artery and its branches were documented. ResultsVariations of the brachial artery anatomy were noted in 3 specimens (5%). Unilateral high bifurcation of brachial artery was noted in two specimens on the left side. In one of these, bifurcation was directly from the axillary artery at the axilla just proximal to the formation of the median nerve. Here the brachial artery divided into its terminal radial and ulnar branches. In the other specimen, the brachial artery bifurcated into radial and ulnar arteries at the level of the mid humerus. In the other specimen, the brachial artery was seen to trifurcate into radial, ulnar and common interosseus arteries at the level of the neck of the radius. ConclusionsHigh brachial artery bifurcation and trifurcation of the brachial artery in the upper arm was noted in this study. Reporting of such variations in different populations is important for the practicing clinician during diagnostic and surgical procedures.

High brachial artery bifurcation

High brachial artery bifurcation

High bifurcation of brachial artery – a case report

High bifurcation of brachial artery – a case report

High bifurcation of brachial artery with superficial radial artery in the left upper limb

High bifurcation of brachial artery with superficial radial artery in the left upper limb

Retraction Statement: Unrecognized High Brachial Artery Bifurcation is Associated with Higher Rate of Dialysis Access by Dr. Lee Kirksey

The above article from Seminars in Dialysis, published online on 4 September 2011 in Wiley Online Library (http://wileyonlinelibrary.com) has been retracted by agreement among the journal's Editor-in-Chief, Richard A. Sherman MD, the journal's North American editor of ASDIN content at the time, Arif Asif MD, and Wiley Periodicals, Inc. The decision to retract was agreed upon following notification by Dr. HeeJun Yang, the author of an article published in 2008, "Variations of the Superficial Brachial Artery in Korean Cadavers." Figure 1 (A & B) and Figure 2 (A-C) in the Kirksey article (1), which originally appeared in the 2008 article by Dr. Yang, were used without authorization or permission from Dr. Yang or the article's publisher. Reference Kirksey L: Unrecognized high brachial artery bifurcation is associated with higher rate of dialysis access. Semin Dial 24(6):698-702, 2011. doi: 10.1111/j.1525-139X.2011.00923.x.

A case report of a high brachial artery bifurcation in relation to clinical significance of artificial arteriovenous fistula

Introduction: The brachial artery starts at the inferior border of teres major and ends by dividing into ulnar and radial arteries in cubital fossa region. The radial artery frequently arises at the level of the neck of the radius and runs along the lateral side of the forearm. Case report: During routine teaching for undergraduate medical student of the upper limb, atypical brachial artery bifurcation giving a high origin of the radial and ulnar arteries was found in the right upper limb of a male cadaver. The bifurcation level was proximal to the interchonylayar line. After that, the ulnar artery descends and gives prominent common interosseous artery at the neck of radius. Conclusion: This case report of vascular variability of the upper limb is to alert vascular radiologists and surgeons as well as nephrologist to prepare a modified surgical intervention of arteriovenous fistula in renal haemodialysis. There is always great vascular variability of the upper limb therefore it is important to be aware of anatomical variation and to avoid iatrogenic fault.

Racial and Gender Differences in Arterial Anatomy of the Arm

Prior studies have shown racial and gender differences with respect to maturation of arteriovenous fistulas. Women and minorities have lower maturation rates for unclear reasons. Small arterial diameter and high brachial artery bifurcation (HBB) are also implicated in reduced maturation rates. We sought to correlate differences in upper extremity arterial anatomy to race and gender. All upper extremity vascular mapping ultrasounds from 2013 to 2014 were retrospectively reviewed. A total of 509 arms in 284 patients were evaluated. Men had significantly higher mean arterial diameters than women at the elbow brachial (4.7 vs 3.9 mm, P < 0.01) and wrist radial arteries (2.1 vs 1.9 mm, P = 0.03). There were 20 (7%) patients with HBB of at least one arm, and 7 (2.5%) patients with bilateral HBB. African-American patients had significantly higher rates of both unilateral HBB (15.9% vs 5.4%, P = 0.02) and bilateral HBBs (9.1% vs 1.3%, P = 0.01). In conclusion, men had significantly larger arteries than women, and African-Americans had a higher rate of HBB than non-African-Americans. Consideration should be given for routine preoperative ultrasound to assess arterial anatomy before arteriovenous fistulas creation, particularly in women and in African-Americans.

AIUM Practice Parameter for the Performance of Ultrasound Vascular Mapping for Preoperative Planning of Dialysis Access

AIUM Practice Parameter for the Performance of Ultrasound Vascular Mapping for Preoperative Planning of Dialysis Access

High brachial artery bifurcation – A case report

High brachial artery bifurcation – A case report

Vascular anatomy relevant to distal biceps tendon repair

Avoiding bleeding and vascular complications in open repair of distal biceps tendon rupture requires knowledge of the local vascular anatomy. This study examined the vascular anatomy relevant to distal biceps tendon repair. The antecubital regions of 17 cadaveric upper extremities were dissected using ×2.5 loupe magnification to identify the brachial artery, the radial artery and its recurrent branches, and venous branches crossing the distal biceps tendon. With the elbow in full extension and supination, the position of each vascular structure was measured relative to the most proximal aspect of the bicipital tuberosity. The most common pattern (13 of 17 specimens) was a single radial recurrent artery (RRA) crossing volar to the tendon at a mean of 4 mm proximal to the tuberosity and positioned 15.4 mm volar to the tuberosity. The RRA bifurcated 2 to 9 mm from its origin in 6 arms and demonstrated a single bifurcation. In 8 of 17 specimens, an additional recurrent branch off the brachial artery traveled dorsal to the intact biceps tendon 16 mm proximal to the RRA. Two arms demonstrated a high brachial artery bifurcation. The crossing veins were venae comitantes of the RRAs and radial and ulnar arteries. They connected to the superficial veins by way of a perforating branch. Most often, 3 transverse veins positioned on average 0.2 mm proximal and 16 mm volar to the tuberosity were seen. The vascular anatomy encountered during distal biceps repair is variable, and RRAs occasionally travel dorsal to the biceps tendon. Most often, a single RRA on average 4 mm proximal to the tuberosity will branch once.

Ultrasound Mapping of Arterial and Venous Patterns of the Upper Extremities in Patients with End-Stage Renal Disease

Objectives We sought to (1) to determine prevalence of high brachial artery bifurcation, forearm cephalic-arm cephalic connection, forearm cephalic-arm basilic vein alternate connection, and levels of basilic-brachial vein junction; and (2) to compare average diameters of forearm and arm cephalic and basilic venous segments according to the results of ultrasound mapping of the upper extremities (UE). Methods Consecutive ultrasound mappings were performed in 100 UE of 23 women, 69 ± 12 (47–84), and 27 men, 62 ± 12 (34–79) years of age. Brachial, radial and ulnar arteries and cephalic and basilic veins were scanned from wrist to axilla. Results Brachial artery bifurcation at the proximal/mid arm was noted in 25 UE of 18 subjects. Arm (a) or forearm (f) cephalic (ce) or basilica (ba) veins were absent in 18 (ace), 15 (fce), 10 (aba), and 14 (fba) UE, respectively. A forearm cephalic-arm cephalic vein connection was noted in 67 UE; of these, 9 (13.6%) also had a significant forearm cephalic-arm basilic connection. A primary forearm cephalic-arm basilic connection was noted in 5 UE, one with a secondary connection to the arm cephalic vein. The basilic joined the brachial vein at the proximal, proximal-mid, mid, mid-distal and distal arm in 29, 17, 26, 4, and 2 UE; a complex connection to radial/ulnar veins was noted in 14 UE. Average diameters were 4.2 ± 1.4 (1.2–7.8), 3.1 ± 1.1 (0.6–6.3), 2.9 ± 0.9 (1.4–4.9), and 2.2 ± 0.9 (0.7–4.5) mm for the arm basilic, arm cephalic, forearm cephalic and forearm basilic veins. Conclusions A significant prevalence of anatomical anomalies was noted, justifying mapping of the upper extremity vasculature prior to planning an arteriovenous fistula or prosthetic graft in patients with end-stage renal disease.

Asymmetric Bilateral Variations in the Musculocutaneous and Median Nerves with High Branching of Brachial Artery

Brachial Plexus is formed by the union of the anterior rami of cervical 5, 6, 7, 8 and thoracic 1 nerves. These nerves unite and divide to form the key nerves innervating the upper limb. Variations in the course of these nerves are clinically important to anesthetists, neurologists and orthopedicians. We report bilateral variations in the arterial and neural structures in the upper limb of a 65 year old cadaver. The muscles of the arm on one side were innervated by the median nerve with absence ofmusculocutaneous. While on the other side the musculocutaneous nerve contributed to the formation of the median nerve. There was a presence of high bifurcation of brachial artery on both sides. Knowledge of such variations in the innervations of muscles and the arterial supply of the limbs are important to remember before performing any reconstructive procedures or interventions on the limb.

Unilateral High Division of Brachial Artery with Common Trunk of Origin for Radial and Profunda Brachii Arteries

Variations in the arterial pattern of upper limb are of common observation during cadaveric dissections, surgical procedures and radiological imaging. The pattern of arterial variations and their relationship with neighboring structures is of clinical importance. Most of the arterial variations in the upper limb are of radial and ulnar arteries. Brachial artery variations and mid arm variations are rare. During routine dissection of an adult cadaver high bifurcation of brachial artery into a larger ulnar artery and a short trunk that further subdivided into profunda brachii and superficial radial arteries was observed in the right upper limb.

High Brachial Artery Bifurcation: Clinical Considerations and Practical Implications for an Arteriovenous Access

High brachial artery bifurcation (HiBAB) is not a rare occurrence. Recent data have emphasized that HiBAB can have major clinical implications including high failure rate and decreased functional patency of an arteriovenous (AV) fistula. In this retrospective study, we investigated the incidence of HiBAB. Patients with advanced chronic kidney disease and end-stage renal disease on chronic hemodialysis undergoing preoperative vascular mapping for the creation of an AV access were included in this analysis. Ultrasound examination was used to map the arteries of the upper extremities. Four hundred and eighty-one arms in 340 patients were examined (right arm = 181, left arm = 300). Sixty-nine of the 481 (12.3%) demonstrated HiBAB. The internal diameter of the radial and ulnar arteries measured at the elbow region was found to be 2.9 ± 0.8 and 3.6 ± 1.0 mm, respectively (p = 0.0001). There were no statistically significant differences in terms of race, gender, and right versus left arms regarding the incidence of HiBAB. As HiBAB can be present in a significant number of patients and have an impact on the AV access, its presence should be evaluated during vascular mapping prior to an AV access creation.

Retracted: Unrecognized High Brachial Artery Bifurcation is Associated with Higher Rate of Dialysis Access Failure

A thorough consideration of all factors contributing to successful dialysis access creation is necessary to achieve optimal outcomes. A high bifurcation of the brachial artery (brachioradial variant) occurs in greater than 20% of patients. Dialysis access was created in 22 limbs with this variant--15 fistula, and 7 prosthetic grafts. Nonmaturation occurred in 33% of fistula. Early thromboses occurred in 29% of prosthetic bridge grafts. In this experience, the brachioradial variant is associated with a relatively higher rate of fistula nonmaturation and prosthetic graft thromboses. These findings reinforce the critical role of preoperative imaging studies in dialysis access creation. A sound algorithm for the surgical management of the brachioradial variation facilitates decision making and will improve dialysis access outcomes.

High Brachial Artery Bifurcation is Associated with Failure of Brachio-Cephalic Autologous Arteriovenous Fistulae

Although European Best Practice Guidelines on vascular access recommend universal pre-operative duplex scan in patients receiving brachio-cephalic (BC) arteriovenous fistulae (AVF), this is not widespread practice. Furthermore, cadaveric and angiographic studies suggest that variation in upper limb arterial anatomy is common. Our aim was to investigate the prevalence of high brachial artery bifurcation (HB) and its impact on BC AVF patency. A retrospective analysis of consecutive autologous BC AVF created over an 18-month period (January 2008 to June 2009). Patients with high bifurcations identified at duplex scan were compared with a control group who had normal bifurcations. All patients were followed up at 1, 6 and 12 weeks post-operatively. The study endpoint was AVF patency. One hundred and five autologous BC AVF procedures were performed in our institution, of which 29 (27.6%) were identified as having a high brachial bifurcation on pre-operative duplex scan. The bifurcation was axillary in six patients and located at the proximal, middle and distal third of the humerus in nine, seven and seven patients, respectively. The actuarial functional patency rate was 53.2% (standard error = 9.6%) in the HB group and 76.2% (standard error = 4.9%) in the control group (log-rank test, p=0.027). These data show that aberrant brachial artery anatomy is both common (12%) and a predictor of autologous BC AVF failure. These data support the universal use of pre-AVF duplex scanning.