Superficial Brachial Artery Research Articles

Superficial Brachial Artery Continuing into the Forearm as a Radial Artery: Case Report

Superficial Brachial Artery Continuing into the Forearm as a Radial Artery: Case Report

Superficial Brachial Artery Continuing into the Forearm as a Radial Artery: Case Report

Superficial Brachial Artery Continuing into the Forearm as a Radial Artery: Case Report

Superficial femoral artery pseudoaneurysm at implantation site of drug eluting stent discovered due to bacteremia: A case report

BACKGROUND Drug-eluting stents (DES) are used to treat lower extremity arterial disease. During DES treatment, aneurysmal degeneration occasionally occurs, especially with fluoropolymer-based DES. However, the incidence of pseudoaneurysms after DES placement is rarely reported in the lower extremity region, although there have been several reports on pseudoaneurysm formation after DES pla-cement in the coronary artery region. CASE SUMMARY We report the case of a 64-year-old man who presented with fever and pain in his left hand after dialysis. Bacteremia was diagnosed by blood culture, and after admission, he developed pain on the medial side of the right thigh. A pseudoaneurysm was observed in the right superficial femoral artery (SFA) at the proximal end of a previously placed DES. The bacteremia was thought to have been caused by a pseudoaneurysm of the left superficial brachial artery, and the pseudoaneurysm of the left superficial brachial artery was removed after antibiotic treatment. The pseudoaneurysm of the right SFA rapidly expanded after admission, but the expansion rate was reduced after infection control. Seven months after the first admission, the pseudoaneurysm of the left SFA was re-moved and in situ revascularization performed using a rifampicin-soaked Dacron graft. CONCLUSION Although pseudoaneurysm after DES placement in the lower extremity region is rare, it must be considered in patients with bacteremia.

The axillary artery high bifurcation: coexisting variants and clinical significance.

Several branching patterns of the axillary artery (AA) have been described. Unusually, the brachial artery (BA) follows a course in front of the median nerve (MN), the so-called superficial brachial artery (SBA). The SBA may result in MN entrapment. The current cadaveric report highlights a high AA bifurcation, its continuation as SBA and the coexistence of muscular, neural, and vascular asymmetric aberrations. At the right side, the coracobrachialis muscle (CB) had a single head, and the ipsilateral musculocutaneous nerve (MCN) followed a medial course. The AA was highly divided into superficial and deep stems (SAS and DAS), at the 2nd rib lower border. Between two stems, the brachial plexus (BP) lateral and medial cords were identified. The MN originated from the BP lateral cord. The SAS, continued as SBA with a tortuous course. The DAS coursed posterior to the BP medial and lateral cords and gave off the subscapular artery. A bilateral 3rd head of the biceps brachii was identified. The MN atypically originated from the BP lateral cord. At the left side, the two-headed CB was typically penetrated by the MCN. A common trunk of the circumflex humeral arteries was identified in coexistence with an interconnection of the BP lateral cord with the MN medial root. The rare coexistence of muscular, neural, and arterial variants in axillary and brachial region is emphasized, taking into consideration the AA high division and related branching pattern. Documentation of such rare vascular variants is important in aneurysm and trauma surgery, and angiography, where all therapeutic manipulations must be accurately performed due to the possibility of complications.

Morphological variations of the brachial artery and their clinical significance: a systematic review

PurposeMorphological variations of the brachial artery are quite commonly discovered in routine dissection and have been the subject of many studies. However, there is a need for a clear classification. This work presents morphological variations of the brachial artery, based on numerous case reports and studies created for the appropriate classification and interpretation among surgeons and radiologists. It also discusses the most important clinical aspects of the given varieties.MethodsThe research method is based on the combined interpretation of the researches based on numerous publications concerning both the principles of correctly classifying the described morphological variations of the brachial artery and the resulting clinical implications. This work considers atypical variations such as the presence of the superficial brachial artery, brachoradial artery, accessory brachial artery and absence of the brachial artery. Variations of the brachial artery in relation to the external and internal diameter of the vessel have also been discussed.ResultsAfter conducting a complex analysis of the collected data, the fundamental principles for classifying such variability as superficial brachial artery, brachioradial artery and accessory brachial artery were defined. Additionally, clinical implications resulting from the above like the impact of the superficial brachial artery on the median nerve neuropathy and the positive correlation between the brachioradial artery and increased danger of incorrect transradial catheterization were demonstrated.ConclusionsThe clinical implications of the atypical arterial pattern within the upper limb are crucial during the angiography and surgical procedures so the variations affect the appropriate diagnosis and surgical intervention. Hence, the knowledge about the morphological variations of the brachial artery should be constantly broadened by radiologists and surgeons to improve the accuracy and effectiveness of the treatment process.

Neural and Arterial Variations in the Right Upper Limb of a Single Cadaver- A Case Report

Background: During routine undergraduate dissection of a 43 years old male cadaver some important neural and arterial anatomic variations were seen in a single right upper limb in the form of double medial roots of median nerve and superficial brachial artery. Observation: During routine dissection of a 43-year-old male cadaver, some important neural and arterial anatomical variations were observed in a single right upper limb in the form of double medial roots of the median nerve and superficial brachial artery. The median nerve was formed in axilla by the union of one lateral and two medial roots on lateral side of axillary artery. The brachial artery which crossed the median nerve superficially from the medial to the lateral side, in the middle of the arm, continued as the superficial brachial artery. The variations were observed and photographed. Conclusion: The knowledge of such variations is however not only desirable, but also essential as these have important influences on the predisposition to illness, clinical examination, investigations and patient management, including operative surgery.

High Bifurcation of Superficial Brachial Artery

High Bifurcation of Superficial Brachial Artery

Study of course and termination of brachial artery by dissection and computed tomography angiography methods with clinical importance.

The Brachial artery is a continuation of the axillary artery, from the inferior border of the tendon of teres major to the neck of the radius, terminating into radial and ulnar arteries just a cm distal to the elbow joint. Unlike veins, variations in the arteries are comparatively less common. Anatomical variations of the brachial artery occur in almost 20% of the cases and are commonly found during routine dissection or clinical practice. To observe the variations in the course and termination of brachial artery by dissection and computed tomography (CT) angiography methods. The present study was conducted on 40 upper limbs each in the department of Anatomy & Radiology of JSS Medical College and Hospital, Mysuru. The brachial artery was traced from origin to termination and variations were noted and photographed. Patients who were undergoing CT angiography of the upper limbs in JSS Hospital were included in the study. Variations noted and compared with the dissection method. In the present study, normal patterns of the brachial arterial course and termination were observed in 31 specimens. The remaining 9 specimens showed variant course and termination in the brachial artery like an unusually tortuous superficial brachial artery, superficial brachio-ulnar artery and brachio-radial artery. CT angiography showed 6 variations and a tortuous brachial artery. A detailed description of the vascular pattern of upper limbs especially variations in their origin and termination is of extreme importance in clinical practice. The knowledge of these variations is important for catheterization, graft harvesting, arteriovenous fistula creation, shunt application and astrup examination.

Study of Variations in the Course of Brachial Artery: A Cadaveric Study

Background: Brachial artery begins as a continuation of axillary artery at the distal border of teres major, runs downward at first medial to the humerus and then inclines to lie in front of the bone until it appears in the cubital fossa, where it ends at the level of the neck of radius by dividing into radial and ulnar arteries. Objectives: To know the variations in the course of brachial artery. Methods: Dissection was done on 40 upper limbs from embalmed adult human cadavers in the Department of Anatomy, Kamineni Institute of Medical Sciences, Narketpally. Dissection of Brachial artery was carried out according to Cunningham’s manual of practical anatomy. Results: In all 40 specimens (100%), the brachial artery begins at the inferior border of the teres major muscle as the continuation of the axillary artery. In 37 specimens (92.5%), single brachial artery (BA) was present in the arm. It runs inferiorly on the medial side of the biceps brachii muscle to the cubital fossa. It divides into the radial artery (RA) and ulnar artery (UA) opposite the neck of radius at elbow. In 3 specimens (7.5%), doubling of the brachial artery in its course was observed. In these specimens, the brachial artery was divided into two divisions in the arm. Both divisions runs inferiorly on the medial side of the biceps brachii muscle to the cubital fossa. In these two divisions, one lies superficial to the median nerve and was called the superficial brachial artery (SBA) and other division continues as the brachial artery proper (BAP). In all these 3 specimens (7.5%), the superficial brachial artery (SBA) continued as the radial artery (RA) and brachial artery proper (BAP) continued as the ulnar artery (UA) in the cubital fossa. Interpretation and Conclusion: The present study is important for Surgeons, Orthopedicians, Vascular surgeons, Clinicians and Anatomists as it provides the knowledge of variations in the course of brachial artery in the arm and cubital fossa. KEY WORDS: Brachial artery, Superficial brachial artery, Cubital fossa. Radial artery.

Anatomical variations of forearm arteries: A literature review

Introduction: The formation of the arterial system of the upper limb takes place in several stages during embryonic development. Several arterial variations in the branching pattern are observed and studied. It is suggested that arterial variants of the arm and forearm arise through the persistence, enlargement and differentiation of parts of the initial arterial network which would normally remain as capillaries or even regress. The present review aims at the anatomical approach of the arm and forearm with special reference to the variations of the arteries in these anatomical areas. Methods: We conducted a search of reviews using the PubMed Database and the Book of Radiology by Wacker F. et al (2017) referring to the anatomical variants of the forearm and their frequency in the general population. Results: Regular hematosis of the forearm (with the presence of the radial, the ulnar and the interosseous artery) was studied in 81 out of 100 bodies at the Laboratory of the Descriptive Anatomy of the Medical School, University of Athens. All the forearm’s arteries ramify from the brachial artery at 68%. All the forearm’s arteries ramify from the superficial brachial artery at 7%. Forearm’s superficial arteries are present in 10%. Presence of the median artery (embryo remnant) is found at a rate of 9%. Conclusions: The anatomical variants of the arteries of the arm and forearm are related to the clinical practice. The deeper knowledge of the above anatomical variants of the arteries is especially important for surgeons, when they perform invasive procedures, such as the elevation of radial forearm flap or dermal flap. It is also of great importance for radiologists and orthopaedic and plastic surgeons for the proper design of surgical procedures involving the arteries of the upper limb. Finally, the peripheral branch pattern of the brachial artery is important for vascular surgeons.

Unusual Multiple Arterial Variations of the Upper Limb

During routine dissection of a 64-year-old male cadaver, multiple variations were observed in the arteries of the upper extremities. The first part of the axillary artery did not give any branches. The second part, after giving superior thoracic and thoracoacromial arteries divided into deep and superficial brachial arteries. Superficial brachial artery gave lateral thoracic artery and continued into the arm. After giving anterior circumflex humeral artery, the deep brachial artery trifurcated into the subscapular artery, posterior circumflex humeral artery, and profunda brachii artery. Understanding upper limb arterial variations are important for performing safer clinical procedures.

Arterial blood supply patterning of the mammary sentinel lymph nodes with special reference to the relation of the formation mechanism of the superficial subscapular artery.

This study aimed to conduct a detailed anatomical examination of the arterial supply to level Ib lymph nodes corresponding to mammary sentinel lymph nodes. This was achieved by focusing on the relationship with course changes of the axillary artery trunk using 41 cadavers (49 axillae). The course patterns of the axillary artery were classified as: "Standard type," which penetrate the brachial plexus (occurrence rate, 51%); "Superficial brachial artery type," which ran along the superficial layer of the brachial plexus (2%); "Superficial subscapular artery (SSbsA) type," which entered the deep layer without penetrating the brachial plexus (42.9%); and others (4.1%). The lateral thoracic artery, thoracodorsal artery, inferior pectoral artery, and superficial thoracic artery were distributed in a regular pair relationship according to each running type of the axillary artery for the Ib lymph nodes. Comparing blood supply ratio to the Ib lymph nodes, using SSbsA occurrence as a reference, showed that significant differences were observed with the inferior pectoral artery control for the standard subscapular artery group and the lateral thoracic artery control for the SSbsA group (p < 0.0001). It was suggested that in selective modeling of vascular networks during upper limb developments, two formation tendencies occur. The standard axillary and SSbsA axillary artery trunks are induced when the inferior pectoral artery-derived feeding arteries in the superficial brachial artery system are selected for Ib lymph nodes, or lateral thoracic artery-derived feeding arteries, which are closely related to the SSbsA pathway, are acquired.

A cadaveric study of brachial artery and its variations with its ontogenic basis: An Anatomical Perspective

Introduction: Conventional knowledge of the brachial artery, the principal artery of the upper limb &amp; its branches has played a major role in vascular surgeries. Literature along with various cadaveric &amp; clinical studies suggest that brachial artery vary widely in origin, course and branching pattern. The great variability of this arterial pattern may be attributed to the failure of regression of some paths of embryonic arterial trunks. Anatomical knowledge of this principal artery and its variations has many clinical implications especially in surgeries related to orthopedic and vascular re-constructive procedures. MATERIALS AND METHODS: The present study was conducted on 56 upper limbs of different age group and sex (19 Male and 9 Female) The brachial arteries were identified and branching pattern and relations of the brachial artery with brachial plexus in arm was observed and presence or absence of variations were documented. Results: Out of 56 upper limbs studies, 53 (94.64%) limbs showed normal morphological pattern of brachial artery, 3 (5.35%) limbs showed superficial brachial artery, 1 limb (1.78%) showed tortuous and SBA with trifurcation into radial artery, ulnar artery and common interosseous artery in the cubital fossa. Conclusion: The study of Brachial artery and variation in its course and branching pattern is clinically important for surgeons, ortho-paedicians operating on the supracondylar fracture of humerus and radiologists performing angiographic studies on the upper limb. KEY WORDS: Common Interosseous Artery, Median Nerve, Superficial Brachial Artery, Trifurcation, Ulnar Artery.

An Unusual Case of Primate Arterial Pattern in a Human Upper Limb

During routine undergraduate dissections of the upper limb, variations on the usual arterial and muscular patterns were observed in a 68 year-old male cadaver. The arterial and muscular pattern found in our specimen is similar to that of some primates in the following terms. 1) Brachial artery duplicity, on the right side, with a superficial brachio-ulnoradial artery. 2) In the right upper limb, the biceps brachii muscle continued with the superficial muscles of the forearm. 3) The brachial artery on the left side, cross over in front of the median nerve, as the only artery of the arm with a network axillary pattern. 4) On both sides, the ulnar artery was superficial and originated at the elbow from superficial brachial arteries. 5) The right anterior interosseous artery intervened in the vascularization of the hand. These results suggest that this may be a case of early detention of human embryonic development and/or the persistence of phylogenetic older patterns. In the literature, we have found no reference to the presence of all these variations in the same individual. The objective of our study was to analyze these variations from an embryological and phylogenetic perspective.

Identifying Variants and Prevalence of the Superficial Brachial Artery – A Case Series

Superficial brachial artery (SBA) is the term used for when the brachial artery (BA) itself or an early branch from the BA travels superficial to the roots of the median nerve (MN) or the MN itself. The purpose of this study was to determine the prevalence of the aforementioned SBA variations, to identify early branching variants of the SBA, and to explore the appropriateness of the anatomical terminology of these SBA variants due to ambiguity in the nomenclature. Assessment of 87 cadavers (174 upper extremities) led to the discovery of nine (5.2%) SBA variations which were observed in a total of seven (8.0%) cadavers (five females, two males). Three different SBA variation types were observed: Variation 1 was identified when the entire BA ran superficial to the median nerve roots, present in 1 of 174 limbs (0.57%); Variation 2 was noted when the BA bifurcated proximal to median nerve roots, resulting in superficial brachial and brachial arteries, seen in 6 of 174 limbs (3.4%); and Variation 3, wherein the BA bifurcated distal to the median nerve roots at the location of an additional connection between the musculocutaneous and median nerves, also resulting in superficial brachial and brachial arteries in 2 of 174 limbs (1.1%). The branches of the BA were followed to discern their branching patterns distally. In the six examples described as Variation 2, four (67%) of the SBAs traveled distally to become the radial artery only (Variation 2A), and two (33%) traveled distally to become both the radial and ulnar arteries (Variation 2B). For the two examples identified as Variation 3, both of the SBA vessels turned into solely the radial arteries distally. Therefore, Variations 2A and 3 both travel distally to become solely the radial artery; however, there is confusion in the literature as to whether these SBA variants can also be called high origin radial arteries (HORAs). Therefore, clarification of the current criteria for naming these brachial artery variants will also be discussed. Due to the unusual locations of SBAs, these variant arteries may cause confusion during surgery and in the interpretation of imaging studies.Support or Funding InformationWV Research Challenge Fund [HEPC.dsr.17.06]

High Bifurcation of the Brachial Artery: An Embryological Overview.

The brachial artery is the main artery of the arm and constitutes the continuation of the axillary artery. It gives off two terminal branches, the radial and ulnar arteries. According to the literature, the brachial artery might present a deviation from the normal pattern in 20% of the cases. High bifurcation of the artery seems to be the most common variation and may result in a series of complications during surgery and interventional radiology. An embryological overview is necessary for a better understanding of this variant. The brachial artery is being developed during embryonic life by the main trunk of the axis artery. The superficial brachial artery is also an important stable fetal vessel for normal arterial morphogenesis of the upper limb.

Gross anatomical adaptations of the craniolateral forearm muscles in Tamandua mexicana (Xenarthra: Myrmecophagidae): development of accessory muscles and rete mirabile for its arterial supply

The northern tamandua (Tamandua mexicana) is a xenarthran mammal with a distribution from Mexico to Peru. This species arrives to wildlife care centres due to illegal trafficking and attacks by domestic dogs, both of which are situations where the northern tamandua's thoracic limbs (forelimbs) can be affected. As such, it is necessary to have anatomical studies that allow us to perform better medical and surgical procedures. Among these, studies about the musculoskeletal system also aid in the muscular reconstructions of extinct species. The aim of this study was to characterize the craniolateral muscles of the forearm in Tamandua mexicana and compare them with other Xenarthrans to determine their gross adaptations. Six dead specimens were used, and none were sacrificed for the purpose of this investigation. In five specimens, arterial repletion was done. Four were fixed with 10% formaldehyde and 5% glycerin, and two were dissected in fresh. All were dissected in the Veterinary Anatomy Laboratory of the Universidad del Tolima. The weights of the muscles from seven forearms were taken and divided in three functional groups for comparison with non-parametric statistics. Two muscular groups were found: one superficial formed by the brachioradialis, brachioradialis accesorius, extensor carpi radialis, extensor digitorum communis, extensor digitorum lateralis and extensor carpi ulnaris; and one deep muscular group formed by the supinator, extensor digiti III et IV, abductor digiti I longus, and extensor digiti I et II. They were supplied by different branches of the cranial interosseous, transverse cubital and superficial brachial arteries, which had the shape of rete mirabile; and all muscles were innervated by the deep branch of the radial nerve. The presence of the brachioradialis accesorius muscle in this species allows its hand to remain in semi-supination when it is mobilized in a quadrupedal manner. It must also support elbow flexion together with the action of the brachioradialis and the extensor carpi radialis muscles. All the antebrachial digital muscles sent tendons for the digit III making it the most functional for different grip activities such as climbing trees and searching for its food, however, the most strength was directed to supination and carpal extension, and therefore also to the flexion of the elbow.

Superficial brachial artery traversing a median nerve loop in the arm associated with other vascular and muscular anomalies: case report and clinical implications

Knowledge of the various morphological patterns of the brachial artery and median nerve in the upper limb area is of considerable clinical and surgical importance to physicians intervening with these areas. In the current study, in the right upper limb of a male cadaver a rare variation of a superficial brachial artery associated with a median nerve loop in the upper arm is presented. The artery gave off a deep brachial artery in the arm and normally bifurcated in the cubital fossa. Additionally, a muscular bundle from the brachialis muscle was also present, overlapping the median nerve along with the deep brachial artery above the elbow. To the best of our knowledge such a combination of arterial, neural and muscular anatomical variations is extremely rare. Since brachial plexus and brachial artery variations are more prone to injury, their surgical, diagnostic and interventional importance are valuable to radiologists in interpreting images and to vascular surgeons, neurosurgeons and orthopedic surgeons involved in compressive peripheral neuropathy treatment. The relevant clinical and surgical implications are discussed as well.

Anatomical Study of the Brachial Plexus in the Common Marmoset (Callithrix Jacchus).

To elucidate the forelimb phylogeny of primates, anatomical analysis of the brachial plexus in platyrrhines is beneficial. In the present study, six brachial plexuses and the surrounding arteries of four common marmosets were dissected. In five specimens, the brachial plexus consisted of five ventral rami from the fifth cervical nerve (C5) to the first thoracic nerve (T1). In one specimen, the ventral ramus of the fourth cervical nerve joined with the brachial plexus. In five specimens, the upper trunk was composed of C5 and the sixth cervical nerve (C6). In one specimen, the ventral division of C6 merged with the ventral branch of the middle trunk to constitute the lateral cord. The seventh cervical nerve constituted the middle trunk, and the eighth cervical nerve and T1 formed the lower trunk in all specimens. The lateral cord gave rise to the musculocutaneous nerve, and the remaining component merged with the medial cord. The confluence of the lateral and medial cords immediately bifurcated into the median and ulnar nerves. These branching patterns of the musculocutaneous, median, and ulnar nerves were consistent and similar to the human counterparts. In the dorsal division, the single posterior cord as observed in the human brachial plexus was not observed. The axillary artery did not pass between the medial and lateral roots of the median nerve, and the axillary artery bifurcated into the brachial artery and the superficial brachial artery. Anat Rec, 300:1299-1306, 2017. © 2017 Wiley Periodicals, Inc.

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.