open access

Vol 83, No 1 (2024): Folia Morphologica
Case report
Submitted: 2023-02-06
Accepted: 2023-03-24
Published online: 2023-04-03
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The axillary artery high bifurcation: coexisting variants and clinical significance

George Tsakotos1, Konstantinos Natsis2, George Triantafyllou1, Trifon Totlis2, Dimitrios Chytas3, Georgia Kostare1, Vasilios Karampelias1, Athina Tousia4, Maria Piagkou1
·
Pubmed: 37016781
·
Folia Morphol 2024;83(1):200-206.
Affiliations
  1. Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, Greece
  2. Department of Anatomy and Surgical Anatomy, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
  3. Basic Sciences Laboratory, Department of Physiotherapy, University of Peloponnese, Sparta, Greece
  4. Department of Forensics and Toxicology, National and Kapodistrian University of Athens, Greece

open access

Vol 83, No 1 (2024): Folia Morphologica
CASE REPORTS
Submitted: 2023-02-06
Accepted: 2023-03-24
Published online: 2023-04-03

Abstract

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.

Abstract

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.

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Keywords

superficial brachial artery, high origin, variation, accessory head, axilla, brachial plexus, entrapment

About this article
Title

The axillary artery high bifurcation: coexisting variants and clinical significance

Journal

Folia Morphologica

Issue

Vol 83, No 1 (2024): Folia Morphologica

Article type

Case report

Pages

200-206

Published online

2023-04-03

Page views

417

Article views/downloads

373

DOI

10.5603/FM.a2023.0027

Pubmed

37016781

Bibliographic record

Folia Morphol 2024;83(1):200-206.

Keywords

superficial brachial artery
high origin
variation
accessory head
axilla
brachial plexus
entrapment

Authors

George Tsakotos
Konstantinos Natsis
George Triantafyllou
Trifon Totlis
Dimitrios Chytas
Georgia Kostare
Vasilios Karampelias
Athina Tousia
Maria Piagkou

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