open access

Vol 83, No 1 (2024): Folia Morphologica
Case report
Submitted: 2022-09-29
Accepted: 2022-12-21
Published online: 2023-01-26
Get Citation

Unique case of vascularization: superficial brachial artery and radial persistent median artery

Megan K. Kalinowski1, Jeffery M. Bettag1, Julian A. Giakas1, Ankita Joshi1, Minh N. Pham1, James C. Yang1, Maurice N. Maglasang1, Yun Tan2, Daniel Daly2
·
Pubmed: 36794686
·
Folia Morphol 2024;83(1):207-214.
Affiliations
  1. Saint Louis University School of Medicine, Saint Louis, MO, United States
  2. Center for Anatomical Science and Education, Saint Louis University School of Medicine, Saint Louis, MO, United States

open access

Vol 83, No 1 (2024): Folia Morphologica
CASE REPORTS
Submitted: 2022-09-29
Accepted: 2022-12-21
Published online: 2023-01-26

Abstract

During a routine cadaveric dissection of a 93-year-old male donor, unique arterial variations were observed in the right upper extremity. This rare arterial branching pattern began at the third part of the axillary artery (AA), where it gave off a large superficial brachial artery (SBA) before bifurcating into the subscapular artery and a common stem. The common stem then gave off a division for the anterior and posterior circumflex humeral arteries, before continuing as a small brachial artery (BA). The BA terminated as a muscular branch to the brachialis muscle. The SBA bifurcated into a large radial artery (RA) and small ulnar artery (UA) in the cubital fossa. The UA branching pattern was atypical, giving off only muscular branches in the forearm and a deep UA before contributing to the superficial palmar arch (SPA). The RA provided the radial recurrent artery and a common trunk (CT) proximally before continuing its course to the hand. The CT from the RA gave off a branch that divided into anterior and posterior ulnar recurrent arteries, as well as muscular branches, before it bifurcated into the persistent median artery (PMA) and the common interosseous artery. The PMA anastomosed with the UA before entering the carpal tunnel and contributed to the SPA. This case presents a unique combination of arterial variations in the upper extremity and is clinically and pathologically relevant.

Abstract

During a routine cadaveric dissection of a 93-year-old male donor, unique arterial variations were observed in the right upper extremity. This rare arterial branching pattern began at the third part of the axillary artery (AA), where it gave off a large superficial brachial artery (SBA) before bifurcating into the subscapular artery and a common stem. The common stem then gave off a division for the anterior and posterior circumflex humeral arteries, before continuing as a small brachial artery (BA). The BA terminated as a muscular branch to the brachialis muscle. The SBA bifurcated into a large radial artery (RA) and small ulnar artery (UA) in the cubital fossa. The UA branching pattern was atypical, giving off only muscular branches in the forearm and a deep UA before contributing to the superficial palmar arch (SPA). The RA provided the radial recurrent artery and a common trunk (CT) proximally before continuing its course to the hand. The CT from the RA gave off a branch that divided into anterior and posterior ulnar recurrent arteries, as well as muscular branches, before it bifurcated into the persistent median artery (PMA) and the common interosseous artery. The PMA anastomosed with the UA before entering the carpal tunnel and contributed to the SPA. This case presents a unique combination of arterial variations in the upper extremity and is clinically and pathologically relevant.

Get Citation

Keywords

persistent median artery, superficial brachial artery, brachial arterial variation

About this article
Title

Unique case of vascularization: superficial brachial artery and radial persistent median artery

Journal

Folia Morphologica

Issue

Vol 83, No 1 (2024): Folia Morphologica

Article type

Case report

Pages

207-214

Published online

2023-01-26

Page views

583

Article views/downloads

400

DOI

10.5603/FM.a2023.0007

Pubmed

36794686

Bibliographic record

Folia Morphol 2024;83(1):207-214.

Keywords

persistent median artery
superficial brachial artery
brachial arterial variation

Authors

Megan K. Kalinowski
Jeffery M. Bettag
Julian A. Giakas
Ankita Joshi
Minh N. Pham
James C. Yang
Maurice N. Maglasang
Yun Tan
Daniel Daly

References (39)
  1. Acarturk TO, Tuncer U, Aydogan LB, et al. Median artery arising from the radial artery: its significance during harvest of a radial forearm free flap. J Plast Reconstr Aesthet Surg. 2008; 61(10): e5–e8.
  2. Adnan G, Yandrapalli S. Radial artery coronary bypass. StatPearls. 2022.
  3. Barfred T, Højlund AP, Bertheussen K. Median artery in carpal tunnel syndrome. J Hand Surg Am. 1985; 10(6 Pt 1): 864–867.
  4. Barner HB. Conduits for coronary bypass: strategies. Korean J Thorac Cardiovasc Surg. 2013; 46(5): 319–327.
  5. Beran SJ, Friedman RM, Kassir M. Recurrent digital ischemia due to thrombosis of the persistent median artery. Plast Reconstr Surg. 1997; 99(4): 1169–1171.
  6. Buch C, Devora CM, Johnson LY, et al. Incomplete superficial palmar arch and bilateral persistent median artery. Int J Surg Case Rep. 2019; 58: 205–207.
  7. Carroll MA, Blandino J, Flynn A, et al. Neurovascular axillary variations: superficial brachial artery and single-corded brachial plexus. Anat Sci Int. 2021; 96(1): 161–167.
  8. Chakravarthi KK, Ks S, Venumadhav N, et al. Anatomical variations of brachial artery - its morphology, embryogenesis and clinical implications. J Clin Diagn Res. 2014; 8(12): AC17–AC20.
  9. Chen Li, Chen J, Hu B, et al. Sonographic findings of the bifid median nerve and persistent median artery in carpal tunnel: a preliminary study in chinese individuals. Clinics (Sao Paulo). 2017; 72(6): 358–362.
  10. Claassen H, Schmitt O, Wree A. Large patent median arteries and their relation to the superficial palmar arch with respect to history, size consideration and clinic consequences. Surg Radiol Anat. 2008; 30(1): 57–63.
  11. D'Costa S, Narayana K, Narayan P, et al. Occurrence and fate of palmar type of median artery. ANZ J Surg. 2006; 76(6): 484–487.
  12. Dickinson JC, Kleinert JM. Acute carpal-tunnel syndrome caused by a calcified median artery. A case report. J Bone Joint Surg. 1991; 73(4): 610–611.
  13. Eid N, Ito Y, Shibata MA, et al. Persistent median artery: cadaveric study and review of the literature. Clin Anat. 2011; 24(5): 627–633.
  14. Fricker R, Fuhr P, Pippert H, et al. Acute median nerve compression at the distal forearm caused by a thrombosed aneurysm of an epineural vessel: case report. Neurosurgery. 1996; 38(1): 194–196.
  15. George BJ, Henneberg M. High frequency of the median artery of the forearm in South African newborns and infants. S Afr Med J. 1996; 86(2): 175–176.
  16. Haładaj R, Wysiadecki G, Dudkiewicz Z, et al. Persistent median artery as an unusual finding in the carpal tunnel: its contribution to the blood supply of the hand and clinical significance. Med Sci Monit. 2019; 25: 32–39.
  17. Henneberg M, George BJ. A further study of the high incidence of the median artery of the forearm in Southern Africa. J Anat. 1992; 181(Pt 1): 151–154.
  18. Huelin JG, Barreiro FJ, Barcia EC. Radio-anatomic study of the median artery. Acta Anat (Basel). 1979; 105(3): 250–255.
  19. Ikeda A, Ugawa A, Kazihara Y, et al. Arterial patterns in the hand based on a three-dimensional analysis of 220 cadaver hands. J Hand Surg Am. 1988; 13(4): 501–509.
  20. Jeon SY, Lee K, Yang WJ. Carpal tunnel syndrome caused by thrombosed persistent median artery - A case report. Anesth Pain Med (Seoul). 2020; 15(2): 193–198.
  21. Jones NF, Ming NL. Persistent median artery as a cause of pronator syndrome. J Hand Surg Am. 1988; 13(5): 728–732.
  22. Kele H, Verheggen R, Reimers CD. Carpal tunnel syndrome caused by thrombosis of the median artery: the importance of high-resolution ultrasonography for diagnosis. Case report. J Neurosurg. 2002; 97(2): 471–473.
  23. Khashaba A. Carpal tunnel syndrome from thrombosed persistent median artery. J Emerg Med. 2002; 22(1): 55–57.
  24. Kopuz C, Gülman B, Bariş S. Persistent median artery: an anatomical study in neonatal and adult cadavers. Kaibogaku Zasshi. 1995; 70(6): 577–580.
  25. Muratore T, Ozer K. Persistent median artery in a pediatric trauma patient: case report. J Hand Surg Am. 2011; 36(4): 658–660.
  26. Natsis K, Iordache G, Gigis I, et al. Persistent median artery in the carpal tunnel: anatomy, embryology, clinical significance, and review of the literature. Folia Morphol. 2009; 68(4): 193–200.
  27. Natsis K, Piagkou M, Panagiotopoulos NA, et al. An unusual high bifurcation and variable branching of the axillary artery in a Greek male cadaver. Springerplus. 2014; 3: 640.
  28. Nayak SR, Krishnamurthy A, Kumar SjM, et al. Palmar type of median artery as a source of superficial palmar arch: a cadaveric study with its clinical significance. Hand (N Y). 2010; 5(1): 31–36.
  29. Nunoo-Mensah J. An unexpected complication after harvesting of the radial artery for coronary artery bypass grafting. Ann Thorac Surg. 1998; 66(3): 929–931.
  30. Osiak K, Elnazir P, Mazurek A, et al. Prevalence of the persistent median artery in patients undergoing surgical open carpal tunnel release: A case series. Transl Res Anat. 2021; 23: 100113.
  31. Patnaik M, Paul S. Persistent median artery of the forearm and palm: a cadaver study into its origin, course, fate and clinical significance. Ital J Anat Embryol. 2016; 121(1): 88–95.
  32. Patnaik VVG, Kalsey G, Singla Rajan K. Palmar arterial arches-A morphological study. J Anat Soc India. 2002; 51: 187–193.
  33. Proudman TW, Menz PJ. An anomaly of the median artery associated with the anterior interosseous nerve syndrome. J Hand Surg Br. 1992; 17(5): 507–509.
  34. Rodríguez-Niedenführ M, Sañudo JR, Vázquez T, et al. Median artery revisited. J Anat. 2002; 195(1): 57–63.
  35. Singer E. Embryological pattern persisting in the arteries of the arm. Anat Rec. 2005; 55(4): 403–409.
  36. Singla RK, Kaur N, Dhiraj GS. Prevalence of the persistant median artery. J Clin Diagn Res. 2012; 6(9): 1454–1457.
  37. Tsagarakis M, Tarabe M, Minoyiannis N, et al. Management of traumatic complete laceration of the median artery at the carpal tunnel: repair or ligate? Plast Reconstr Surg. 2004; 114(4): 1014–1015.
  38. Yang HJ, Gil YC, Jung WS, et al. Variations of the superficial brachial artery in Korean cadavers. J Korean Med Sci. 2008; 23(5): 884–887.
  39. Yoshinaga K, Tanii I, Kodama K. Superficial brachial artery crossing over the ulnar and median nerves from posterior to anterior: embryological significance. Anat Sci Int. 2003; 78(3): 177–180.

Regulations

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By VM Media Group sp. z o.o., Grupa Via Medica, Świętokrzyska 73, 80–180 Gdańsk, Poland

tel.: +48 58 320 94 94, faks: +48 58 320 94 60, e-mail: viamedica@viamedica.pl