Third Part Of Axillary Artery Research Articles

AN OBSERVATIONAL STUDY ON ANATOMICAL VARIATIONS OF BRACHIAL ARTERY AND ITS CLINICAL IMPLICATIONS

Introduction: rd Brachial artery, the principal artery of the arm, begins as the continuation of 3 part of axillary artery at the level of lower border of teres major muscle and ends at the level of the neck of radius by dividing into radial and ulnar arteries. There are wide variations in the course, termination and branching pattern of brachial artery. The present study was done in Methods: 30 cadavers in department of anatomy, K.P.C. Medical College, Kolkata to nd out anatomical variations of the brachial artery. Mean length of the brachial artery Observation And Results: was 26.74 cm on the right side and 27.12cm on the left side. In 3.33% cases brachial artery runs supercial to the median nerve. The brachial artery divided below the intercondylar line in 93.33% cases and above the intercondylar line in 6.67% cases. In one cadaver radial artery and ulnar artery arose directly from the third part of axillary artery on both sides. The profunda brachii artery arose from brachial artery in 95% cases, from third part of axillary artery in 3.33% cases and from high origin of radial artery in 1.67% cases. In proximal part of the arm the median nerve was found anterior to the brachial artery in 91.67%, medial to the artery in 5% and posterior to the artery in 3.3% cases. The knowledge of Conclusion: variations of brachial artery and its branching pattern are useful for physicians, surgeons, interventional radiologist in various surgical, diagnostic and therapeutic procedures.

Anatomical variation of median nerve: cadaveric study in brachial plexus.

Median nerve is formed by lateral root from lateral cord and medial root from medial cord of brachial plexus. Formation of median nerve occur in front or lateral to axillary artery in axilla. In the present study we observed anatomical variations of median nerve formation in the brachial plexus. We examined formalin fixed 60 upper limbs from 30 adult cadavers (15 males and 15 females) which were above the age 40 years from the department of Anatomy. All the cadavers were dissected on both sides according to Cunningham’s Manual of Practical Anatomy. Normal formation of median nerve by two roots noted in 42 (70.0%) of upper limb specimen. Variation of median nerve formation noted in 18 (30.0%) upper limb specimen. Three roots taking part in the formation of median nerve in 13 (21.7%) upper limb specimen where additional root coming from lateral cord of brachial plexus. Four roots taking part in formation of median nerve in 3 (5.0%) upper limb specimen, where additional roots coming from lateral cord and posterior cord of brachial plexus. Lateral root crossed the axillary artery anteriorly to join with medial root lying medial to axillary artery. The median nerve formed medial to third part of axillary artery. Additional communication with musculocutaneous nerve with median nerve seen in 2 (3.3%) upper limb specimen. Knowledge of such anatomical variations is of interest to the anatomist and clinician alike. Surgeons who perform procedures involving neoplasm or repairing trauma need to be aware of these variations. Median nerve variation may lead to confusions in surgical procedures and axillary brachial plexus nerve block anesthesia.

BILATERAL VARIATION IN THE BRANCHING PATTERN OF THE AXILLARY ARTERY - A CASE REPORT

During routine dissection of a male cadaver for I year MBBS students in the department of Anatomy bilateral variations in the branching pattern of Axillary artery were observed. In the present study it was observed that, on the left side, the subscapular artery which usually arises from the third part of Axillary artery was found to be originating from the second part along with the lateral thoracic artery and thoraco-acromial artery whereas anterior circumflex humeral artery and posterior circumflex humeral artery originated from the third part as usual. On the right side, the circumflex scapular artery and the Thoracodorsal artery were arising as a common trunk from the third part which is not the usual pattern. Knowing such variations is of utmost significance in performing various clinical procedures by Vascular surgeons, Radiologists, Clinical anatomists and in interventional and diagnostic procedures in cardiovascular diseases.

Bilateral variation in origin of thoracodorsal artery along with non-piercing variant of musculocutaneous nerve on left side

Subclavian artery continues as axillary artery in the axilla and is the principal source of blood supply of the lateral thoracic wall, axilla, scapular region, and upper limb. Thoracodorsal artery is one of the terminal branches of subscapular artery, which in turn is branch from the third part of axillary artery. Musculocutaneous nerve, a branch from lateral cord of brachial plexus, is the chief nerve supply of anterior compartment of arm, commonly seen piercing the coracobrachialis muscle before continuing as lateral cutaneous nerve of forearm. In the current case report, thoracodorsal arteries on both sides were arising from lateral thoracic artery, branch of second part of axillary artery and the left musculocutaneous nerve was not piercing the coracobrachialis muscles. Also, there was a communication between left musculocutaneous nerve and left median nerve. The knowledge about normal and variant pattern of origin and course of branches of axillary artery is very important as it may help the surgeons to identify the source of bleeding during surgeries in region of shoulder or axilla. Also, post-surgical complication or symptoms of nerve repair can be explained by the variation in course of musculocutaneous nerve and its communication with median nerve.

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A CADAVERIC STUDY ON THE ANATOMICAL VARIATIONS OF THE MUSCULOCUTANEOUS NERVE IN RELATION WITH MEDIAN NERVE AND CORACOBRACHIALIS MUSCLE

Introduction: Musculocutaneous nerve is derived from the lateral cord of brachial plexus and supplies the muscles of the arm. Initially the nerve accompanies the lateral side of third part of axillary artery and then pierces the coracobrachialis muscle after supplying it, passes downwards and laterally in between biceps brachii and brachialis sending branches to both and continues as lateral cutaneous nerve of the forearm. Variations of musculocutaneous nerve is important for surgeons, orthopedic surgeons and traumatologists, so a detailed cadaveric study of musculocutaneous nerve was done to observe the variations. Material & Methods: Musculocutaneous nerve was studied in 50 human cadavers (30 males and 20 females) of age group 40-60 years at Department of Anatomy, Subharti Medical College, Meerut, India. Results: Musculocutaneous nerve was present in all the cases and was piercing the coracobrachialis muscle. In 4% of the cases, the nerve was rejoining the median nerve after piercing the coracobrachialis.

Unilateral variation in branching pattern of Right Axillary Artery - A Case Report

The Axillary artery is the continuation of the subclavian artery and is a major artery of the upper limb. During the routine dissection for Undergraduate Ayurvedic Medical Students of Sharada Ayurvedic Medical College, Yadgir, Karnataka, India, in the Department of Anatomy, we come across a variation in branching pattern of second and third part of right axillary artery in male cadaver approximately 55 years of age. The first part of axillary artery was found to be normal. In the second part of axillary artery we observed two branches, first one is thoracoacromial artery arose as usual second branch given common trunk which is further divided into lateral thoracic artery and subscapular artery. Even third part of axillary artery gave one common trunk that terminated by bifurcating into Anterior Circumflex Humeral Artery and Posterior Circumflex Humeral Artery.

Bilateral brachio-antebrachial arterial variations with ontogenic explanation

During dissection in the Department of Anatomy, a female cadaver was encountered with arterial variations bilaterally. From third part of axillary artery, a branch was observed running superficial to median nerve, which was called as superficial brachial artery. The axillary artery after passing through the two roots of median nerve continued as normal (deep) brachial artery. The course of superficial and deep brachial arteries was different on both sides. Common interosseous artery was observed as a branch of radial artery bilaterally. Also, ulnar artery was seen entering the hand passing deep to flexor retinaculum bilaterally, which may get affected in carpal tunnel syndrome. It is important for the clinicians to have knowledge of such variations. An attempt has also been made to explain the variations ontogenically.

Amputation for upper extremity ischemia following shoulder dislocation: case report and a review of literature

Injury of the axillary artery following glenohumeral dislocation is a very rare situation. The mechanisms for arterial injuries are lacerations, rupture, avulsion of main branches or intimal tears and pseudo aneurysm formations. In this report we present an upper extremity ischemia following shoulder dislocation resulting with loss of extremity. Our aim was to highlight the importance of the third part of axillary artery and consequences of underestimation of vascular pathologies following shoulder injuries.

Variations in the arteries of upper limb- an ontogenic explaination

During routine dissection in the department of Anatomy, Padmashree Dr.D.Y.Patil Medical College,Pimpri, Pune,variation of brachial artery was found. It was labeled as superficial brachial artery as it was arising from third part of axillary artery and was superficial to nerves and vessels of axilla .This superficial brachial artery was dividing into Radial and Ulnar arteries. Also Common trunk for Subscapular and Anterior circumflex scapular arteries was seen arising from axillary artery. Its embryological basis is also discussed along with details of observations.

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The present case report describes one of the rare unilateral variations in the formation of median nerve by the union of three roots, twin (two) roots given off by the lateral cord and one root given off by the medial cord encountered in the right upper arm of an adult male cadaver during the pro-section hours. From the lateral cord which was seen lateral to the third part of axillary artery the musculocutaneous nerve and the twin lateral roots were seen arising very close to each other. The musculocutaneous nerve coursed laterally to innervate the coracobrachialis muscle. The origin of twin lateral roots was just medial to the origin of musculocutaneous nerve. The first lateral root which emerged proximal to the shoulder and united with the medial root and formed the median nerve was labeled as LR - 1, the second lateral root which fused with the already formed median nerve was labeled as LR - 2, In fact the second lateral root LR - 2, and the musculocutaneous nerve had a common point of origin seen as small bulge. The second lateral root LR - 2, was slightly thicker in its diameter and longer in course than the first root LR - 1 and it maintained its individual identity for about 3.5 cm before merging with the median nerve lying antero-lateral to it. The median nerve was seen forming anterior to the third part of axillary artery which continued as brachial artery. The knowledge of the formation, course and distribution with all the possible variations is an essential pre- requisite for traumatologists, neurologists, surgeons performing shoulder arthroscopy by anterior gleno-humeral portal and shoulder reconstructive surgeries, neuro-surgeons

Anomalous third part of axillary artery- anatomical, embryological and clinical relevance

DOI: http://dx.doi.org/10.3126/jcmsn.v7i3.6711 Journal of College of Medical Sciences-Nepal, 2011, Vol-7, No-3, 43-47

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.

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.

A Rare Variant Formation Of The Median Nerve: A Case Report

Variations in the formation of median nerve are common but this case report is the rare variation of formation of the median nerve posterior to the third part of axillary artery. During educational dissection of undergraduate students of the academic year 2007-2008 in our department of anatomy, the two roots of the median nerve joined behind the axillary artery to form the median nerve, which coursed behind the brachial artery and then crossed to the medial part of cubital fossa. The lateral root passed between the axillary artery and anterior circumflex humeral artery to course to the back to join the medial root of median nerve. This variation may be clinically important because symptoms of median nerve compression arising from similar variations are often confused with more common causes such as radiculopathy and carpal tunnel syndrome.

The pectoralis major muscle flap—a first choice for shoulder disruption injuries

Significant soft tissue losses may follow surgical excision of soft tissue tumours or areas of radionecrosis. These procedures are planned and the anatomical relationships of the axilla are usually left undisturbed. Because of its long pedicle and axis of rotation the latissimus dorsi muscle flap is usually the first choice for shoulder reconstruction. With gleno-humeral disruption the third part of axillary artery and its terminal branches are at risk of injury. In these circumstances the reliability of the latissimus dorsi cannot be guaranteed. We present five such cases treated in South Africa by the senior author. All were reconstructed using a pectoralis major muscle flap.

Multiple arterial anomalies in upper limb

An isolated neurovascular variation is common but multiple vascular anomalies on same upper limb is a very rare case. We observed an unusual variations in right upper limb during routine dissection of a Nepali cadaver. The variations were observed in Axilla, Forearm and Palm. In axilla, fi rst part of axillary artery did not give any branch, the second part of axillary artery gave off only two branches - (a) thoracoacromial artery and (b) a large common trunk which later gave off lateral thoracic, thoracodorsal, subscapular, posterior circumflex scapular and then continued as posterior circumflex humeral artery. The third part of axillary artery gave off only anterior circumflex humeral artery. In forearm, the ulnar artery runs downward superficial to flexor muscles. Here, radial artery gave off common interosseous artery. In palm radial artery did not give any contribution to superficial palmar arch which is solely formed by the continuation of ulnar artery. This type of anomalies are very rare and is not reported in Nepalese cadaver at all. These anomalies are described in detail and their clinical relevance is highlighted.