Posterior Circumflex Humeral Artery Research Articles

A Rare Anomalous Artery Originating From Axillary Artery

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.

Anomalous Branching Pattern of the 3rd Part of Axillary Artery

Axillary artery is the principal artery of the upper limb. It is also the axis artery of the upper limb. The present case was found in a male cadaver aged around 70years. During the routine cadaveric dissection of undergraduate students in J.J.M.M.C Davangere we found that 3rd part of axillary artery divided into a larger superficial brachial artery and a narrower deep brachial artery. The superficial brachial artery did not give any branches in the arm and divided into radial and ulnar arteries at the neck of the radius. Whereas the deep brachial artery gave rise to subscapular artery, anterior and posterior circumflex humeral arteries and profunda brachial artery. The knowledge of such type of variation is important for surgeons, orthopedicians and interventional radiologists who operate in this region.

Unusual branching pattern of axillary artery associated with the high origin of ulnar artery

Axillary artery is a continuation of subclavian artery, extending from the outer border of first rib to the lower border of teres major muscle. During routine dissection for the undergraduate medical students, a rare variations was seen in an approximately 55-year-old male cadaver. This case showed a variation in branching pattern of right axillary and subscapular arteries. The subscapular artery originated from 2nd part of axillary artery, gave origin to posterior circumflex humeral and lateral thoracic arteries in addition to its normal branches. The ulnar artery originated from the 3rd part of the axillary artery, just above the lower border of teres major muscle. The variant ulnar artery passed deep to the median cubital vein, bicipital aponeurosis, and tendon of palmaris longus muscle. Then, it passed superficial to flexor digitorum superficialis muscle and flexor retinaculum to enter the palm. In the palm, it formed the superficial palmar arch. This variant ulnar artery was much smaller in caliber than the radial artery.

A Unique Branching Pattern of the Axillary Artery: A Case Report

During routine dissection classes for under graduate students, we found a unique and unusual case regarding the anomalous branching in the third part of the axillary artery was terminated into subscapular arterial trunk, superficial brachial artery and deep brachial artery. The subscapular arterial trunk was origin of several important arteries as the circumflex scapular, thoracodorsal, posterior circumflex humeral, thoraco-acromial and lateral thoracic arteries. The deep brachial artery in the arm gave anterior circumflex humeral artery at the surgical neck of humerus, which terminated in the cubital fossa by dividing into radial and ulnar arteries. The superficial brachial artery gave two profunda brachii arteries, both of which passed through spiral groove, along with radial nerve and three muscular branches, to brachialis muscle. This variation is very rare. As per our knowledge, we did not find any literature which explained variations which were similar to this. The normal and abnormal anatomy of the axillary region has practical importance among vascular radiologists and surgeons and it should be known for making an accurate diagnostic interpretation.

Arterial supply of the tendinous rotator cuff insertions: an anatomical study

Confirming the presence of arteries crossing the osteotendinous junctions (OTJs) of the rotator cuff may explain why rates of avascular necrosis (AVN) of the humeral head vary between three- and four-part proximal humeral fractures. It is hypothesized that the humeral head remains better vascularized in three-part fractures because one tuberosity with its inserting rotator cuff tendons is still attached to the articular fragment and supplying it with blood. Eighty rotator cuff tendons from 20 shoulder girdles of cadavers aged 68-94 years were studied. In six shoulder girdles, the anterior circumflex humeral artery and posterior circumflex humeral artery (PCHA) were injected with ink, and the extra- and intraosseous courses of the vasculature were dissected until the OTJs of the rotator cuff. The rotator cuff insertions received an arterial supply across their OTJs in 50% of cases (75% in supraspinatus, 67% in subscapularis, 33% in infraspinatus and 20% in teres minor). Supraspinatus and subscapularis insertions were vascularized by the arcuate artery, while the insertions of infraspinatus and teres minor were supplied by an unnamed terminal branch of the PCHA. This was named 'posterolateral artery'. The presence of arteries crossing the OTJs of the rotator cuff, as well as the differences in the frequency arteries crossed the OTJs of individual rotator cuff tendons, may help explain why there is a lower rate of AVN of the humeral head in thee-part, compared with four-part proximal humeral fractures.

Treatment of Postburn Anteriorly Located Neck Contractures With Local Flaps

The objective of this study was to summarize our experience of using local flaps for the reconstruction of neck defects after cervical contractures release, particularly of using the extended deltopectoral flaps whose distal margin was beyond the anterior axillary line even reaching dorsalis for reconstruction of anterior neck scar contractures in a single-stage procedure. From 1987 to 2008, neck scar contractures were reconstructed using various local flaps in 68 patients with postburn anteriorly located neck contractures. The local flaps used consisted of 36 deltopectoral flaps, 6 extended deltopectoral flaps, 4 free scapular flaps, 8 neck-shoulder flaps, and 14 Z-plasties. The distal end of extended deltopectoral flaps was transferred as microvascular-free flap provided by the posterior circumflex humeral artery, but the proximal end as pedicle flap supplied by the anterior perforating branches of internal mammary artery. Other flaps were elevated conventionally as described previously in the articles. Of 68 patients, there were 59 cases (86.8%) whose release of the contractures was excellent. For 51 patients, the whole process of treatment was finished only in a single-stage procedure. We used extended deltopectoral flap, which was developed from our own anatomic studies and from previous reports in the literature, in 6 patients. This new flap extends the volume of the original deltopectoral flap, from 22 to 32 cm in length and 10 to 22 cm in width (at the apex). Postoperatively, all flaps survived completely. Patients were satisfied with their results. The follow-up period ranged 1 to 10 years; no obvious recontractures have been noted. There were no severe donor-site complications. The local flap with matching texture, color, elasticity, and pliability is still the best choice for reconstruction of postburn anteriorly located neck contractures. The extended deltopectoral flap has been used successfully to yield satisfactory outcomes for the scar contractures in the anterior neck and should be conserved as a selective method for reconstructive surgeons.

High Prevalence of Self-Reported Symptoms of Digital Ischemia in Elite Male Volleyball Players in the Netherlands

Background: In the past 3 years, 6 volleyball players with ischemic digits and small microemboli in the digital arteries of the dominant hand presented themselves in our hospital. These complaints were caused by an aneurysmatic dilation of the posterior circumflex humeral artery (PCHA) with distal occlusion and digital emboli in the isolateral limb. All were elite male volleyball players active in the national top league. Little is known about the exact symptoms associated with PCHA pathological lesions with digital emboli (PCHAP with DE) and its prevalence in elite volleyball players. If vascular injury can be identified at an early stage, thromboembolic complications and irreversible damage to the digits might be prevented. Purpose: To assess the prevalence of symptoms that are consistent with digital ischemia and may be caused by PCHAP with DE in elite male volleyball players in the Netherlands. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A questionnaire survey was performed among elite volleyball players in the Dutch national top league and the Dutch beach volleyball team. The questionnaire was constructed using literature-based data on symptoms associated with PCHAP with DE, together with data retrieved from medical files. Results: A total of 99 of the 107 athletes participated, with a response rate of 93%. The most frequently reported symptoms associated with PCHAP with DE were cold, blue, or pale digits in the dominant hand during or immediately after practice or competition. The prevalence of these symptoms ranged from 11% to 27%. The prevalence of cold digits during practice and competition was 27%. The prevalence of cold, blue, and pale digits during or immediately after practice and competition was 12%. Conclusion: An unexpectedly high percentage of elite volleyball players reported symptoms that are associated with PCHAP with DE in the dominant hand. Because these athletes are considered potentially at risk for developing critical digital ischemia, further analysis of the presence of digital ischemia and PCHA injury is warranted.

New approach to the study of intraosseous vasculature

The study of intraosseous vasculature has always been challenging due to the hard, calcified structure of bone. Techniques used to study intraosseous vasculature usually involve diaphanization with a Spalteholz technique, followed by X-ray imaging to display the radio contrast-injected blood vessels. These techniques produce results with fine detail when successfully executed. However, high failure rates and the extensive length of time required to perform these techniques are drawbacks. This paper describes a faster, alternative method for the study of intraosseous vasculature. Five embalmed and two fresh shoulder girdles were harvested from six cadavers. Cannulas were inserted into the origins of the anterior (ACHA) and posterior (PCHA) circumflex humeral arteries and injected with ink diluted in water or 6% hydrogen peroxide. The arteries and their branches were dissected until they entered their respective bony foraminae. A hammer, chisel, bone nibbler and mounted needles were used to follow the intraosseous course of these arteries and their branches. The intraosseous vasculature was seen in all specimens. The branches of the main nutrient artery to the proximal humerus were followed until they reached articular cartilage or crossed cortical bone again to enter the rotator cuff tendons. An innovative, new approach to the study of intraosseous vasculature with direct visualization of the intraosseous arteries of the proximal humerus is described.

A case of an extremely rare unilateral subscapular trunk and axillary artery variation in a male Caucasian: Comparison to the prevalence within other populations

A male Caucasian cadaver was found to have a large common trunk that branched off of the first part of the axillary artery of the left arm. This trunk gave rise to all but two arterial branches of the axillary region. The large common trunk first gave off a thoracoacromial artery followed by the main branch, the subscapular artery. The subscapular was the origin of the posterior circumflex humeral and lateral thoracic arteries immediately proximal to bifurcating into its two terminal branches, the circumflex scapular and thoracodorsal arteries. Only the superior thoracic and anterior circumflex humeral arteries arose directly from the axillary artery. Also found was a high origin of the radial artery, noteworthy by its serpentine route. In comparison, in the right arm, no variants appeared in the axillary, subscapular, or brachial arteries. A comparison with branching patterns of axillary arteries from demographically similar and dissimilar populations revealed the extreme rarity of this set of anomalies.

Posterior Circumflex Humeral Artery Injury with Distal Embolisation in Professional Volleyball Players: A Discussion of Three Cases

Presented are three cases of volleyball players with ischaemia of the hand due to arterial emboli originating from an injured posterior circumflex humeral artery (PCHA). An operative treatment with ligation of the PCHA was performed in all patients because of the proximity of the occlusion to the axillary artery. After a rehabilitation programme, all patients could return to their previous level of competition.During overhead motion, the PCHA is prone to injury in its position overlying the humeral head and its course through the quadrilateral space. Recognition of the vascular origin of these symptoms in athletes is important to prevent serious ischaemic complications. Signs of ischaemia might be subtle and may be misdiagnosed as musculoskeletal injuries. Therefore, the examining physician must have a high index of suspicion and awareness about these injuries is important.

Variations in branching pattern of the axillary artery: a study in 40 human cadavers

BACKGROUND: Variations in the branching pattern of the axillary artery are a rule rather than an exception. The knowledge of these variations is of anatomical, radiological, and surgical interest to explain unexpected clinical signs and symptoms. OBJECTIVE: The large percentage of variations in branching pattern of axillary artery is making it worthwhile to take any anomaly into consideration. The type and frequency of these vascular variations should be well understood and documented, as increasing performance of coronary artery bypass surgery and other cardiovascular surgical procedures. The objective of this study is to observe variations in axillary artery branches in human cadavers. METHODS: We dissected 80 limbs of 40 human adult embalmed cadavers of Asian origin and we have studied the branching patterns of the axillary artery. RESULTS: We found variations in branching pattern of axillary artery in 62.5% of the limbs. Anatomical variations included: origin of lateral thoracic artery from the subscapular artery; absent thoracoacromial trunk and all its branches arose directly from the second part of the axillary artery; division of thoracoacromial trunk into deltoacromial and clavipectoral trunks, which were divided into all branches of thoracoacromial trunk; origin of subscapular, anterior circumflex humeral, posterior circumflex humeral and profunda brachii arteries from a common trunk from the third part of the axillary artery; and origin of posterior circumflex humeral artery from brachial artery in addition to third part of the axillary artery. CONCLUSIONS: The study was carried out to show important variations in the branching pattern of axillary artery, in order to orient the surgeons performing angiography, coronary bypass, and flaps in reconstructive surgeries.

Abnormal Division of Axillary Artery - A Case Report

AbstractA case of the abnormal branching of the right Axillary artery in a 60 year old male cadaver is presented here. The axillary artery divided into two trunks, a lateral and medial from the second part only in this case. The lateral branch was superficial running between two roots of median nerve, which here is referred to as superficial branch. The other was a medial trunk, running deep to median nerve on the medial, hence it is referred as deep brachial artery. The superficial branch had a similar course as radial artery coursing on the lateral side of cubital fossa, fore arm, anatomical snuff box and hand, hence it was considered as equivalent to radial artery. The deep brachial artery gave rise to anterior and posterior circumflex humeral arteries and the superior ulnar collateral artery. This variation is rare and the incidence quoted as around 0.12 - 3.2% in the available literature. The normal and abnormal anatomy of the axillary artery is having practical importance for the radiologists during angiography and surgeons for accurate diagnostic interpretation.

Variant Branching Pattern of Axillary Artery: A Case Report

During routine dissection of an approximately 50-year-old male cadaver for the undergraduate medical students at Melaka Manipal Medical College, Manipal University, Manipal, we came across a variation in branching pattern of right axillary artery. The second part of axillary artery gave rise to a common trunk which divided into the subscapular and lateral thoracic arteries. The third part of right axillary artery gave rise to anterior and posterior circumflex humeral arteries. Variations in the branching pattern of axillary artery are important for the surgeons performing interventional or diagnostic procedures in cardiovascular diseases.

Abnormal division of axillary artery - A case report

A case of the abnormal branching of the right Axillary artery in a 60 year old male cadaver is presented here. The axillary artery divided into two trunks, a lateral and medial from the second part only in this case, The lateral branch was superficial running between two roots of median nerve, which here is referred to as superficial branch. The other was a medial trunk, running deep to median nerve on the medial, hence it is referred as deep brachial artery. The superficial branch had a similar course as radial artery coursing on the lateral side of cubital fossa, fore arm, anatomical snuff box and hand, hence it was considered as equivalent to radial artery. The deep brachial artery gave rise to anterior and posterior circumflex humeral arteries and the superior ulnar collateral artery. This variation is rare and the on the right side, where the course and distribution of incidence quoted as around 0.12 - 3.2% in the available literature. The normal and abnormal anatomy of the The axillary artery is having practical importance for the radiologists during angiography and surgeons for accurate diagnostic interpretation.

Variation in the branching pattern of right axillary artery in a malaysian adult male cadaver – a case report.

–Upper limb arterial variations are of potential clinical implications as it is a frequent site of injury and also involved in many invasive and surgical procedures. During routine dissection of the right upper limb of an adult male cadaver in the department of Anatomy, Aimst University,Malaysia variations in the branching patteran of third part of axillary artery were found. It was observed that a common trunk arose from third part of axillary artery which gave rise to lateral thoracic artery, anterior and posterior circumflex humeral arteries. However subscapular artery took its origin separately from the third part of axillary artery. Common trunk was found to be arising from medial side of third part of axillary artery. Some embryological explanations are available with regard to such anomalies. Knowledge of such arterial variations is most importance in carrying out surgical procedures in arm and axilla, also for accurate interpretation of angiography reports by radiologists. Keywords––arterial variations, axillary artery, branching pattern, clinical importance.

Occlusion and stenosis of the posterior circumflex humeral artery: Detection with ultrasound in a normal population

The posterior circumflex humeral artery (PCHA) travels together with the axillary nerve through the quadrilateral space of the shoulder. Angiographic occlusion of this artery upon abduction and external rotation (ABER) of the arm has been accepted as evidence of mechanical compression of the axillary nerve and thus considered pathognomonic of quadrilateral space syndrome (QSS). The specificity of this sign for QSS has however been called into question as there are, to date, limited data on the incidence of axillary neurovascular compression during ABER in a normal population. We set out to determine the rate of stenosis or occlusion of the PCHA on ABER in healthy volunteers using ultrasound. Healthy volunteers asymptomatic for shoulder complaints were recruited from patients attending the clinic for ultrasound imaging not related to the shoulder, as well as volunteers among staff. Doppler sampling of the PCHA of both shoulders of participants was conducted in neutral and abduction and externally rotated positions. Each shoulder was treated as a separate entity. Results showed that 15/93 (16%) of shoulders demonstrated Doppler ultrasound evidence of occlusion or significant stenosis in the absence of shoulder complaints. Occlusion or stenosis of the PCHA on ABER is an uncommon finding in an asymptomatic population. Axillary neurovascular compression is unlikely if colour Doppler ultrasound does not show PCHA compromise during ABER.

Upper extremity ischemia in athletes: Embolism from the injured posterior circumflex humeral artery

Upper extremity ischemia in athletes is caused by embolism from the proximal arterial compromise at the thoracic outlet or under the pectoralis minor. The posterior circumflex humeral artery (PCHA), a branch of the third part of the axillary artery, can also be injured by repetitive overhead activity including the tennis or volleyball game, resulting in aneurysm formation or thrombotic occlusion, and this lesion could be a source of distal embolism. We report two patients with complaints of hand and forearm ischemia due to distal embolism from the aneurysm in one patient and thrombotic occlusion of the PCHA in the other. The former was a 20-year-old amateur tennis player. Angiography revealed an aneurysm of the PCHA and multiple distal embolism. He was treated by resection of the aneurysm and thromboendarterectomy with vein patchplasty of the occluded ulnar artery. Five years after surgery now, he can enjoy playing tennis without new embolic events, although he still has mild ischemic symptoms during playing tennis. The latter was a 17-year-old volleyball player. Angiography showed thrombotic occlusion of the PCHA and embolic occlusion of the digital arteries. Surgical intervention was not required because he decided not to play volleyball. Two years later now, he has had no new episodes of embolism, although he has ischemic symptoms only when cold.

Ultrasound-guided block of the axillary nerve: a volunteer study of a new method

Interscalene brachial plexus block (IBPB) is the gold standard for perioperative pain management in shoulder surgery. However, a more distal technique would be desirable to avoid the side effects and potential serious complications of IBPB. Therefore, the aim of the present study was to develop and describe a new method to perform an ultrasound-guided specific axillary nerve block. After initial investigations, 12 healthy volunteers were included. We performed an in-line ultrasound-guided specific axillary nerve block by injecting 8 ml local anesthetic (lidocaine 20 mg/ml) after placing the tip of a nerve stimulation needle cranial to the posterior circumflex humeral artery in the neurovascular space bordered by the teres minor muscle, the deltoid muscle, the triceps muscle and the shaft of the humerus. Needle placement was aided by simultaneous nerve stimulation. We assessed sensory (pinprick and cold stimulation) and motor (active resistive force) block of the axillary nerve before, 15, 30, 60, 90 and 120 min after performing the block and every 30 min until termination of the block. All 12 volunteers demonstrated sensory block of the axillary nerve and 10 volunteers demonstrated complete motor block. Even though it was difficult to directly visualize the axillary nerve, the block was easy to perform with easily recognizable ultrasonographic landmarks. Block duration was approximately 120 min. We describe a new ultrasound-guided technique to specifically block the axillary nerve. The potential clinical role of this new block remains to be determined.

Anatomical Study of Axillary Artery Variation.

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.

Ultrasound of the posterior circumflex humeral artery

Quadrilateral space syndrome (QSS) is described as compression neuropathy of the axillary neurovascular bundle in the quadrilateral space of the shoulder. This neurovascular bundle includes the posterior circumflex humeral artery (PCHA). Historically, angiography and more recently magnetic resonance angiography have been used to assess occlusion and stenosis of the PCHA in cases of suspected QSS. These traditional imaging techniques have a number of disadvantages in terms of cost, availability, invasiveness and patient comfort. We undertook to examine the ability of ultrasound to reliably visualise the PCHA. Asymptomatic adult volunteers were recruited from staff, and patients attending the radiology department who presented for pathologies unrelated to the shoulder. We used a new technique to assess blood flow in the PCHA, performing the scan from a posterolateral approach on the upper arm just above the level of the surgical neck of the humerus. This technique enabled the scan to be undertaken with the patient seated comfortably. Fifty volunteers were recruited into the study. The mean (+/-SD) age was 35 (+/-14 years). The PCHA was visualised in all patients. Our method was able to maximise Doppler sensitivity and visualisation of the artery without discomfort to the patient in less than 10 min. Ultrasound can be used to reliably visualise the PCHA. Ultrasound has potential to be used in the assessment of the PCHA in cases of QSS.