Persistent Median Artery Research Articles

A Unique Case of Vascular Variations in the Upper Limbs: A Brachioradial Artery and Bilateral Persistent Median Arteries With Incomplete Superficial Palmar Arches

A Unique Case of Vascular Variations in the Upper Limbs: A Brachioradial Artery and Bilateral Persistent Median Arteries With Incomplete Superficial Palmar Arches

Persistent median artery: paedogenesis of the antebrachial arterial system in the human body.

The persistence of the median artery in adult life, a remnant of the early brachial artery in the embryonic stage, has been reported in many anatomical and clinical studies. Herein, we aimed to investigate the prevalence and origin of the median artery in cadavers. We examined 53 adult Japanese cadavers and carefully dissected 106 upper limbs, and the arterial systems in the forearms and hands were observed macroscopically. We found the palmar type of the median artery on 106 sides in 53 cadavers, and found that it passes through the carpal tunnel and forms the superficial palmar arch in the hand in only two cadavers. The antebrachial type, ending in the forearm before reaching the wrist joint, was detected on 63 sides in 44 cadavers. The proportions of the origins of the median artery examined in this study were as follows: originating from the common interosseous artery (CIA) on 15 sides (23%), anterior interosseous artery (AIA) on 9 sides (14%), ulnar artery (UA) on 16 sides (24%), and CIA-UA trunk on 26 sides (39%). None arose from other arteries in the upper limbs. Based on our results and the current theory on vascular development, we conclude that the term 'persistent median artery' must be strictly used for the one that arises from the arteries in the forearm except for the radial artery, and the presence of this ontogenetic remnant can be interpreted as paedogenesis in the human body. We also describe that the increasing trend in the incidence of the median artery since the nineteenth century, as pointed out by a few researchers, may represent 'nearly neutral evolution' at the phenotypic level in human populations.

Bilateral palmar type of persistent median artery: A case report

The persistent median artery (PMA) is an example of a supernumerary artery in the forearm. During embryonic development, the median artery regresses as the ulnar and radial arteries take over the blood supply of the forearm. Non-regression of the median artery will lead to its persistence into adulthood. We are reporting a bilateral presence of a palmar type of PMA, which was a branch of the ulnar artery, and the PMA passed through the carpal tunnel to supply the hand. On the right side, PMA pierced the median nerve in the upper forearm. In the palm, PMA did not form the superficial palmar arch. However, a communicating twig between the PMA and ulnar artery was observed on the left side. The presence of PMA could cause compression of the median nerve, leading to carpal tunnel syndrome. PMA of larger calibre could be used as a graft and in harvesting reconstructive free flap. Knowledge about these vascular variations is important in diagnosing nerve compression syndromes and avoiding unanticipated surgical complications.

Persistent median artery and communicating branch related to the superficial palmar arch

Microvascular surgery, plastic and reconstructive hand surgery, and coronary artery bypass surgery call for a microanatomical study of the branching pattern of the superficial palmar arch (SPA). For the anatomical analysis, we used a group of 20 dissected human hands injected with 4% formaldehyde solution and a 10% mixture of melted gelatin and India ink. The morphometric study was performed on 40 human hands of adult persons injected with methyl-methacrylate fluid into the ulnar and radial arteries simultaneously and afterwards corroded in 40% KOH solution for the preparation of corrosion cast specimens. The mean diameter of the SPA, between the second and third common palmar digital arteries, was 1.86 ± 0.08 mm. We identified the persistent median artery (PMA) in 5% of hands. We distinguished the three main groups of the SPAs according to variations in morphology and branching of the arch: Type 1, the long SPA; Type 2, the middle length SPA; and Type 3, the short SPA found in 27.5% of specimens. The communicating branch (CB), a vessel interconnecting the SPA to the closest branch of the radial artery, is classified into two different morphological groups. The third type of incomplete short arterial arch is the most important of the three groups of SPAs. That short SPA is potentially inadequate for restoring circulation after occlusion or radial artery harvesting for coronary artery bypass.

Median artery persistence in coexistence with a bifid median nerve and interconnections of the median with the ulnar nerve and vice versa

PurposeThis report describes a bilateral persistent median artery (PMA) originating from the ulnar artery and terminating at different levels of the upper limb. The PMA coexisted with a bilateral bifid median nerve (MN) and two bilateral interconnections (ICs characterized with the symbol -) of the MN with the ulnar nerve (UN) (MN-UN) and a unilateral reverse IC (UN-MN). Emphasis was given to the artery’s developmental background.MethodsThe PMA was identified in an 80-year-old formalin-embalmed donated male cadaver.ResultsThe right-sided PMA terminated at the wrist, posterior to the palmar aponeurosis. Two neural ICs were identified: the UN joined the MN deep branch (UN-MN), at the forearm’s upper third, and the MN deep stem joined the UN palmar branch (MN-UN), at the lower third (9.7 cm distally to the 1st IC). The left-sided PMA ended in the palm giving off the 3rd and 4th proper palmar digital arteries. An incomplete superficial palmar arch was identified by the contribution of the PMA, radial, and ulnar arteries. After the MN bifurcation into superficial and deep branches, the deep branches formed a loop, that was penetrated by the PMA. The MN deep branch communicated with the UN palmar branch (MN-UN).ConclusionsThe PMA should be evaluated as a causative factor of carpal tunnel syndrome. The modified Allen's test and the Doppler ultrasound may detect the arterial flow and the angiography may depict the vessel thrombosis in complex cases. PMA could also be a "salvage" vessel for the hand supply, in radial and ulnar artery trauma.

A persistent median artery piercing the median nerve: a review and clinical implications

BackgroundThis case report documents a rare variation of a persistent median artery. Normally a transient vessel present during embryologic development of the limbs, the median artery typically regresses by the eighth week of life as the radial and ulnar arteries predominate the distal vascular supply of the hand. In a subset of the adult population, this artery remains as a persistent median artery which most often ends in the carpal tunnel or hand without significant vascular dependence.Case presentationAn 84-year-old female cadaver was found bilaterally to have an artery that penetrated the median nerve in the forearm, continued through the carpal tunnel, then joined the superficial arch, giving rise to the common digital artery to the second webspace. It also gave rise to the radialis indicis, the princeps pollicis, and an anastomotic branch to the radial artery.ConclusionsThis anatomic variant of a persistent median artery piercing the median nerve, traversing the carpal tunnel, and providing aberrant primary blood supply to a large area of the hand are details clinically relevant to those who treat hand disorders and injuries.

Persistent median artery on computed tomographic arteriovenous fistulograms in patients on haemodialysis.

Cadaveric studies suggest an increasing prevalence of the persistent median artery (PMA) over a prolonged timeframe. The aim of this retrospective cross-sectional study was to evaluate the PMA prevalence in haemodialysis patients who had computed tomographic fistulograms (CTFs), and if present, their calibres and origins. All consecutive adult patients referred for an upper limb CTFs for assessment of arteriovenous fistula (AVF) dysfunction from 2006 to 2021 were included. Patients whose CTF did not include the forearm were excluded. PMA was identified as an artery running alongside the median nerve between flexor digitorum superficialis and flexor digitorum profundus. Patient demographics, presence of PMA including size and origin were recorded. A PMA was found in 91/170 (53.5%) CTFs (7:3 male-to-female ratio, mean age 71-years). When stratified by age, prevalence increased with decreasing age; 51% in >70-year-olds, 54% in 50-70-year-olds and 67% in <50-year-olds. The average PMA diameter was 2.2 mm proximally and 1.8 mm distally. No stenosis was observed in the PMAs. The PMA prevalence appears to increase with decreasing age and is a frequently encountered anatomical variant. Radiologists assessing forearm vasculature need to be aware of this anatomical variant and potentially include it in their future reports. Further research into the PMA may make its potential use as arterial conduits for AVF, potential donor grafts for coronary artery bypass surgery or additional vascular access options possible. Whether the reducing prevalence with age reflects an overall increasing prevalence is yet to be determined.

Carpal Tunnel syndrome secondary to a persistent median artery: A case report

Carpal Tunnel Syndrome is the most common compressive neuropathy, affecting 5% of the population. Most cases are idiopathic

Median Nerve Neuropathy Caused by Persistent Median Artery Thrombosis

Summary: Persistent median artery thrombosis mimicking carpal tunnel syndrome is rare. Here, we report the pathological, ultrasonography, and intraoperative findings of a case of persistent median artery thrombosis mimicking carpal tunnel syndrome. A 34-year-old man reported to our clinic with a complaint of numbness in his left thumb, index finger, and middle finger, which are innervated by the left median nerve. He also reported that he felt pain in his left wrist and distal forearm while working. Although findings of the usual provocative tests and nerve conduction studies were normal, ultrasonography revealed arterial thrombosis at the carpal tunnel level, whereas magnetic imaging showed persistent median artery thrombosis in the carpal tunnel. Three months after surgical resection of the thrombosed section of the artery, the patient fully recovered with no residual pain or limitations in the use of the affected arm. His patient-reported outcomes improved as well. It is important to investigate the existence of persistent median artery thrombosis if a patient presents with atypical symptoms of carpal tunnel syndrome. Ultrasonography is useful for the diagnosis of persistent median artery thrombosis. Surgical resection of a thrombosed persistent median artery in patients with carpal tunnel syndrome yields good results.

Pseudoaneurysm of the Persistent Median Artery: A Rare Vascular Injury

Median artery is usually a transient vessel during the embryonic period and may persist in adult life as the persistent median artery (PMA) in the upper limbs. It remains asymptomatic in most people; however, thrombosis leading to features of carpal tunnel syndrome is one of the known complications. We report a case of pseudoaneurysm of PMA following a trivial injury. This case report highlights the importance of being aware of this anatomical variation, to avoid complications during hand surgeries.

Carpal tunnel syndrome caused by persistent median artery thrombosis with a possible link to COVID-19 vaccination: a case report

The authors present a case of COVID-19 vaccine-related median artery thrombosis.

An Anatomical Variation of Median Artery of Forearm and Palm: Cadaveric Study into its Origin and Course

Background The median artery (transitory artery) represents the forearm’s embryonic arterial axis. At 8th week of gestation retreats into a little canal that supplies the median nerve. Later, ulnar and radial arteries take its place. Adults may still have it in either a palmar or an antebrachial pattern. The persistent median arteries are a long, angular arterial that extends to the hand’s palmar surface. The median artery only partially recedes in the antebrachial type.&#x0D; Objective To identify the median artery distribution in the adult Nepalese population. Method Twenty-five adult human cadavers’ left and right upper limbs undergone to descriptive research. The persistent median artery was exposed according to the Cunningham’s Manual of Practical Anatomy.&#x0D; Result The forearm and hand arteries in each of the fifty upper limbs from the twenty-five formalin-embalmed human cadavers were studied. Among fifty upper limbs, persistent median arteries were found in six (twelve percent) of them. One percent of a cadaver’s right and left limbs had bilateral persisting median arteries (ante brachial). Persistent median artery of the ante brachial type that arises from the anterior interosseous artery in a right upper limb. Persistent median artery emerging from the posterior interosseous arteries were visible in one right upper limb.&#x0D; Conclusion The study showed persistent median artery of ante brachial type. The posterior interosseus artery is the source of the majority of antebrachial type. A median artery piercing the median nerve was discovered.

Carpal tunnel syndrome in rheumatoid arthritis patients: the role of combined ultrasonographic and electrophysiological assessment

BackgroundCarpal tunnel syndrome (CTS) is known as one of the most common neurological extra-articular manifestations in rheumatoid arthritis (RA) patients. Studies on CTS in RA depend mostly on electrophysiological assessment. Few studies have used ultrasonography for evaluation of the local causes with much focus on wrist arthritis and tenosynovitis as the main cause of entrapment neuropathy of the median nerve in RA. The aim of our study is to assess the local causes of carpal tunnel syndrome in rheumatoid arthritis patients by ultrasonography and whether inflammatory or anomalous variations could affect decision-making and patient management.ResultsCarpal tunnel syndrome was diagnosed in 71 out of 74 examined RA wrists by nerve conduction studies (NCSs) and was categorized from minimal to severe according to Padua et al.’s (Ital J Neurol Sci 18:145–50, 1997) grading criteria. Median nerve CSA at the level of the carpal tunnel inlet and flattening ratio showed statistically significant relation with CTS severity. Bifid MN was found in 20 wrists (10 mild CTS wrists and 10 moderate CTS wrists), a persistent median artery was found in 4 wrists with moderate CTS, and an accessory muscle bundle was present in 3 wrists (2 mild CTS and 1 moderate CTS). The majority of the examined hands (85.1%) showed flexor tendon tenosynovitis at the wrist level and radio-carpal joint synovitis. The US7-joint score using GSUS7 & PDUS7 for synovitis, tenosynovitis and erosions showed significant relation with patients’ disease activity by DAS28 score. Significant relations between CTS severity and the following nerve conduction studies’ parameters, median nerve distal motor latency (DML), motor/sensory NCV, peak sensory latency, amplitude of SNAP, and median-radial latency difference test, were observed.ConclusionSynovial inflammation and local causes of median nerve compression such as bifid median nerve, persistent median artery, and accessory muscle bundle are collectively contributing factors in the etiology of carpal tunnel syndrome in rheumatoid arthritis patients. Ultrasonographic visualization of these inflammatory and anomalous variations enables early detection of CTS and highlights the possibility of non-arthritic-related causes. Using the 7-joint ultrasound (US7) score for assessment of synovitis, tenosynovitis, and erosions in rheumatoid arthritis patients is of valuable role in reflecting inflammation and its relation to the development of CTS in RA patients.

Cadaveric study of division of the median nerve by the persistent median artery.

The purpose of this study is to characterize the division of the median nerve by the persistent median artery (PMA) and highlight the associated clinical implications. Penetration of the median nerve by the PMA is believed to cause compression of the median nerve and affect nerve conduction velocity. This paper explored whether the origin and the pattern of PMA dictate its ability to divide the median nerve. Origin, and relationship of the PMA to the median nerve were documented in 60 cadavers donated to the Human Anatomy Program at UT Health San Antonio. Entire path of this artery was followed in the forearm and the hand. Twenty-five cases of a persistent median artery (PMA) were found in the upper limbs (20.83%; 25/120) of these donated cadavers. Most of the persistent median arteries originated from the ulnar artery (48%; 12/25) and the others originated either from the anterior interosseous artery (36%; 9/25) or from the common interosseous artery (16%; 4/25). Sixty percent (15/25) of the persistent median arteries penetrated and divided the median nerve in the forearm. Interestingly, all the persistent median arteries that originated from the ulnar artery (100%; 12/12) divided the median nerve in the forearm and a palmar type of PMA was found to be more likely to divide the median nerve. Clinicians performing surgeries in the forearm and hand need to be aware of this anomaly and should screen patients for the presence of this artery prior to surgical intervention.

A Prospective Evaluation of the Prevalence of Persistent Median Artery in Patients with Carpal Tunnel Syndrome.

The median artery is an embryonic structure that typically regresses during gestation. Occasionally, the artery remains and is then termed a persistent median artery (PMA). A PMA can be associated with other anatomic anomalies, and has been known to contribute to carpal tunnel syndrome (CTS). Recent literature has observed an increase in PMA prevalence, speculated to indicate microevolutionary change. We performed a prospective observational study to investigate the current prevalence rate of PMA in patients undergoing carpal tunnel release (CTR). Institutional review board approval was obtained. From October 2020 to January 2021, patients ≥18 years old undergoing open CTR by 9 orthopaedic hand surgeons were included in analysis. Patients undergoing endoscopic CTR were excluded. Intraoperatively, the carpal tunnel was evaluated for the presence of a PMA, median nerve anomalies, or any other anatomic anomalies. If a patient underwent bilateral CTR during the study, only one side was included in analysis as determined randomly. Three hundred and sixty open CTRs in 327 patients were performed during the study. Twenty-seven PMAs were identified, for an overall prevalence rate of 8.3%. The average age of patients with a PMA was 63.6 years (SD 13.3 years), consisting of 15 men and 12 women. There were no statistical differences in age, gender, or laterality between patients that did and did not have a PMA. Thirty-three patients underwent bilateral CTR during the study, with 3 being found to have a PMA unilaterally, and zero having a PMA bilaterally. Two bifid median nerves (0.6%) were also identified. This study represents the highest prevalence rate of PMA directly observed in CTR patients reported to date (8.3%). A PMA is not a rare finding, and it should be recognized and protected during CTR. Occasionally, a PMA can be the cause of an acute presentation of CTS.

Bifid median nerve as an anatomical risk factor for carpal tunnel syndrome: A meta-analysis.

As the median nerve enters the carpal tunnel, it is a single nerve that soon bifurcates into lateral and medial branches into the hand. If the bifurcation is proximal to the carpel tunnel, a bifid median nerve (BMN) results. Carpal tunnel syndrome is often associated with a BMN with or without a persistent median artery. Individual keywords and MeSH phrases were searched in the Google Scholar, SCOPUS, and PubMed databases. Full texts were then collected and assessed for suitability. The prevalence of BMN at the wrist joint in normal and carpal tunnel syndrome wrists (precanal part) and the mean difference between groups were recorded. Only human data were used to test the findings. The pooled odds ratio (with minimal heterogeneity) was 1.50 [1.17-1.93, 95% CI]. The BMN cross-sectional area (CSA) was significantly greater than that of a solitary median nerve in normal wrists. The mean difference in CSA between the two was 1.50 mm2 [0.56-2.45 mm2 , 95% CI] without heterogeneity (i2 =0). Sex and laterality distributions scarcely differed between the two types of wrists. Owing to the insufficiency of data, the relationships with mean height and weight were not examined. There was a 50% greater incidence of bifid median nerves in carpal tunnel syndrome patients than in normal subjects. A bifid median nerve increases the mean CSA at the wrist joint by 1.5 mm2 . These findings indicate that the bifid median nerve is an anatomical risk factor for carpal tunnel syndrome.

Frequency, variation, and structure of the median artery in a cadaver sample from New Mexico

The median artery is presently understood to be an embryonic structure, which typically begins to regress around the 8th week of intrauterine life. However, this artery can sometimes persist well into adulthood. It can exist as one of two types, forearm or palmar, which is determined by the site of termination. The purpose of this study was to examine the prevalence of the persistent median artery in a sample size of 41 cadavers from the University of New Mexico School of Medicine Anatomy Lab. Additionally, site of origin and termination were recorded. Out of 82 forearms from 41 cadavers, the persistent median artery was observed in eight (9.75%). Of these, five (62.5%) were determined to be the forearm type and three (37.5%) the palmar type. The artery was present bilaterally in only one case (12.5%). The most common site of origin was the common interosseus artery (5; 62.5%), followed by the ulnar artery (2; 25%), and the anterior interosseus artery (1; 12.5%). The persistent median artery was present in close to 10% of this population, which is a lower prevalence than observed in other similar studies. Presence of the persistent median artery is relevant to health care providers and worth considering due to role it may play in conditions such as carpal tunnel syndrome, as it would reduce the available space inside this pathway.

Study of contributing arteries to superficial palmar arch formation

The superficial palmar arch (SPA) is formed predominantly by the ulnar artery with a contribution from the superficial palmar branch of the radial artery.: To study contributing arteries in superficial palmar arch formation and variations in its formation.: Study comprised of 30 upper limbs from 15 cadavers. Palmar arches in them were dissected following classical incisions and dissection procedures of Cunninghams’ manual.: SPA was formed by superficial branch of ulnar artery only in 13.33% specimens, by superficial branch of both ulnar and radial artery in 70% specimens, by superficial branch of ulnar and persistent median artery in 13.33% specimens and was formed by superficial branches of ulnar and radial arteries with persistent median artery in 3.33% specimens. SPA was complete in 80% and was incomplete in 20% specimens.: The arch formation is highly variable. Knowledge of contribution to the SPA will be helpful to the reconstructive hand surgical procedures such as arterial repairs, vascular graft applications and re-implantations.

The persistent median artery: A new challenger in carpal tunnel imaging?

The persistent median artery: A new challenger in carpal tunnel imaging?

The persistent median artery: A case report of maintained perfusion to the hand after laceration to radial and ulnar arteries

The persistent median artery: A case report of maintained perfusion to the hand after laceration to radial and ulnar arteries