Common arterial trunk for the branches of the third portion of the axillary artery: description of a case and its clinical application / Tronco arterial común para las ramas de la tercera porción de la arteria axilar: descripción de un caso y su aplicación clínica

SUMMARY: Variations of the axillary artery may have clinical implications capable of generating unexpected situations during surgical procedures of arterial reconstruction or vascular catheterization. The objective of this work was to report the finding of an anatomical variant of the axillary artery, which may have clinical and surgical implications. A descriptive study was conducted, in which a unilateral vascular variation found during a routine dissection in a right upper limb of a male cadaver was reported. From the second portion of the axillary artery originated a common arterial trunk that gave rise to the subscapular, anterior humeral circumflex, posterior humeral circumflex and deep brachial arteries. The third portion of the axillary artery did not emit branches. The common arterial trunk originated from the second portion, 62.64 mm from the beginning of the axillary artery. Its total length was 23.72 mm and its thickness was 6.1 mm. The caliber of the branches originating from the common arterial trunk was: subscapular artery 5.1 mm, anterior humeral circumflex of 1.66 mm, posterior humeral circumflex 3.18 mm and deep brachial 3.73 mm. The vascular variant detected altered the anatomical relationship of the axillary artery with the brachial plexus, generating a modification in the position of the fascicles and their terminal branches. Anatomical variations of the axillary artery are not infrequent, knowing them may be necessary during surgical procedures or anatomical dissections.

RESUMEN: Las variaciones de la arteria axilar pueden tener implicancias clínicas capaces de generar situaciones inesperadas durante procedimientos quirúrgicos de reconstrucción arterial o cateterismo vascular. El objetivo de este trabajo fue reportar el hallazgo de una variante anatómica de la arteria axilar, la cual puede tener implicancias clínicas y quirúrgicas. Se realizó un estudio de tipo descriptivo, en el cual se reportó una variación vascular unilateral encontrada durante una disección de rutina en un miembro superior derecho de un cadáver de sexo masculino. De la segunda porción de la arteria axilar se originó un tronco arterial común que daba origen a las arterias subescapular, circunfleja humeral anterior, circunfleja humeral posterior y braquial profunda. La tercera porción de la arteria axilar no emitía ramas. El tronco arterial común se originaba de la segunda porción, a 62,64 mm del inicio de la arteria axilar. Su longitud total era de 23,72 mm y su grosor de 6,1 mm. El calibre de las ramas originadas del tronco arterial común fue: arteria subescapular 5,1 mm, circunfleja humeral anterior de 1,66 mm, circunfleja humeral posterior 3,18 mm y braquial profunda 3,73 mm. La variante vascular detectada alteraba las relaciones anatómicas de la arteria axilar con el plexo braquial, generando una modificación en la posición de los fascículos y sus ramos terminales. Las variaciones anatómicas de la arteria axilar son frecuentes, conocerlas puede ser necesario durante procedimientos quirúrgicos o disecciones anatómicas.

A Rare Case of Dysplastic Axillary Artery Aneurysm Associated with Arteriovenous Malformation.

BACKGROUND: Axillary artery aneurysms are rare conditions, and their causes are various. They can determine severe complications, so the treatment is extremely important. METHODS: We report the case of a young man affected by a saccular axillary artery aneurysm associated with intramuscular arteriovenous malformation, without symptoms except for the presence of a pulsatile mass. Duplex scan and computed tomography scan have been essential for a correct diagnosis and planning of the treatment. At first, the patient was submitted to coil embolization of an efferent vessel, and then he was treated surgically through ligation and detachment of the aneurysm and replacement of part of the axillary artery with a Dacron graft (Vascutek, Inchinnan, Renfrewshire, Scotland, UK). RESULTS: Follow-up at 1 and 6 months revealed normal patency of the axillary arterty and the prosthetic graft with complete exclusion and thrombosis of the aneurysm sac.No sensitive nor motor deficit were observed. CONCLUSIONS: Aneurysms of the axillary artery associated with intramuscular arteriovenous malformations are very rare, but have to be suspected. The treatment is challenging and can be surgical, endovascular, or hybrid, based on the patient's conditions and aneurysm's anatomical features.

A rare variation of suprascapular artery originated from the axillary artery / Una rara variación de la arteria supraescapular originada de la arteria axilar

SUMMARY: The suprascapular artery (SSA) has been identified to be of clinical relevance to clavicular fracture, suprascapular neuropathy and surgical intervention of shoulder. Thus its origin and course have been intensively studied. In this case, we found a unilateral variation of the suprascapular artery, originating from the 1st segment of axillary artery, and sequentially penetrating the upper trunk of brachial plexus, passing through the suprascapular notch under the superior transverse scapular ligament. This case will be helpful to clinical management in cervical and shoulder region.

RESUMEN: Se ha identificado que la arteria supraescapular (ASS) tiene relevancia clínica en la fractura clavicular, la neuropatía supraescapular y la intervención quirúrgica del hombro. En consecuencia, su origen y su curso han sido ampliamente estudiados. En este caso, encontramos una variación unilateral de la arteria supraescapular, originada en el primer segmento de la arteria axilar, y que penetraba secuencialmente en el tronco superior del plexo braquial, pasando a través de la incisura supraescapular debajo del ligamento escapular transverso superior. Este caso será útil para el manejo clínico en la región cervical y del hombro.

An unusual case of asymmetrical combined variations of the subclavian and axillary artery with clinical significance.

In a Greek Caucasian male cadaver, a combination of the following arterial variations were observed: an aberrant right subclavian artery originating as a last branch of the aortic arch and coursed posterior to the oesophagus, a right non-recurrent laryngeal nerve, an atypical origin of the left suprascapular artery from the axillary artery, an unusual emersion of the lateral thoracic artery from the subscapular artery and a separate origin of the left thoracodorsal artery from the axillary artery. According to the available literature the corresponding incidences of the referred variants are: 0.7% for the aberrant right subclavian artery, 1.6-3.8% for the origin of the suprascapular artery from the axillary artery, 3% for the origin of the left thoracodorsal artery from the axillary artery and 30% for the origin of the lateral thoracic artery from the subscapular artery. Such unusual coexistence of arterial variations may developmentally be explained and has important clinical significance.

Prevalence of Perforated Graft in Underlay and Pop-in Technique Myringoplasty.

INTRODUCTION: The radial artery is commonly originated from the brachial artery in the cubital fossa at the level of the neck of the radius. It is the artery of choice for coronary artery angiography, percutaneous coronary artery intervention, cannulation, and others. Radial artery anomalies like high origin, tortuosity, and accessory branches are associated with the failure of such procedures. The main objective of this study is to study the variation in origin and course of the radial artery in cadavers. METHODS: A descriptive cross-sectional study was conducted in 27 formalin-fixed adult human cadavers in the Department of Anatomy, KIST Medical College and Teaching Hospital, Lalitpur, Nepal, from 2075/4/2 to 2076/4/2. Ethical approval was taken on date 02/04/2075 (IRC No. 2074/75/38). Altogether, 53 specimens were enrolled in the study by convenience sampling method. Point estimate at 95% Confidence Interval was done for binary data along with frequency and proportion. The data was analyzed by and Statistical Package for the Social Sciences version 20. RESULTS: Out of of 53 upper limbs, forty-six (86.79%) specimens, the origin of the radial artery was observed to be normal in the cubital fossa, 34.5±6.31mm below the level of the intercondylar line of the humerus with the superficial course. In seven (13.21%) specimens, the radial artery showed variation in the origin. Among them, variations in origin were found to be from sites like the axilla, upper-middle, and lower part of the arm. One cadaver showed a tortuous radial artery bilaterally. CONCLUSIONS: This study concludes that most of the radial artery originates in the cubital fossa from the brachial artery with few variations.

Abnormal Communication between Lateral Thoracic Artery and Anterior Circumflex Humeral Artery - a Case Report.

Variations in the branching pattern of axillary artery are observed by many anatomists all over the world. A unique bilateral variation in the axillary artery was observed during the routine dissection of the upper limbs on an approximately 65 year old male cadaver. An abnormal communicative channel was observed between lateral thoracic artery and anterior circumflex humeral artery. It passed between the two roots of median nerve. Arterial anomalies in the upper limb are due to defective remodelling of vascular plexus of the upper limb bud during embryogenesis. Knowledge of variations in axillary artery is quintessential for surgeons, radiologists and anaesthesiologists to avoid treacherous complications during procedures.

A rare case of atypical thoracodorsal artery: a challenge for flap reconstruction.

The thoracodorsal artery mainly supplies the latissimus dorsi muscle. Anatomical details pertaining to the origin and distribution of thoracodorsal artery are important because the latissimus dorsi myocutaneous flap is one of the most reliable and versatile flaps used in reconstructive surgery. Atypical origin and course of the thoracodorsal artery is, therefore, a challenge for flap reconstruction surgeries. In the present case, we report multiple variations in the branching pattern of axillary artery. The thoracodorsal artery had an unusual origin from the second part of axillary artery. The trunk of thoracoacromial artery was absent. The thoracodorsal artery after its origin, descended downwards over the lateral pectoral region lying deep to pectoralis minor but superficial to teres major muscles. It terminated by supplying the latissimus dorsi muscle. Due to the presence of atypical thoracodorsal branch, the subscapular artery continued as the circumflex scapular artery.

Brachiomedian artery (arteria brachiomediana) revisited: a comprehensive review.

This article reviews in detail the superficial brachiomedian artery (arteria brachiomediana superficialis), a very rare variant of the main arterial trunks of the upper limb. It branches either from the axillary artery or the brachial artery, descends superficially in the arm (similar to the course of the superficial brachial artery) and continues across the cubital fossa, runs superficially in the forearm, approaches the median nerve and enters the carpal canal to reach the hand. It usually terminates in the superficial palmar arch. The first drawing was published, in 1830, and the first description was published, in 1844. Altogether, to our knowledge, only 31 cases of a true, superficial brachiomedian artery have been reported (Some cases are incorrectly reported as superficial brachioradiomedian artery or superficial brachioulnomedian artery). Based on a meta-analysis of known, available studies, the incidence is 0.23% in Caucasians and 1.48% in Mongolians. Knowing whether or not this arterial variant is present is important in clinical medicine and relevant for: The catheterization via the radial or ulnar artery; harvesting the vascular pedicle for a forearm flap based on the radial, ulnar or superficial brachiomedian arteries; the possible collateral circulation in cases of the arterial closure; and the surgical management of carpal tunnel syndrome. Its presence can elevate the danger of an injury to the superficially located variant artery or of an accidental injection.

Anomalous branching patterns of the axillary artery / Patrones de ramificación anómalos de la arteria axilar

Arterial variations in the upper limbs can cause iatrogenic injury during invasive procedures. During educational dissection of countered uncommon branching patterns of the axillary artery which have not yet been reported yet, to our knowledge. First, the second part of the axillary artery was divided into three trunks. The lateral trunk ran downward as a superficial brachioradial artery. The medial trunk raised the lateral thoracic artery, and was divided into the subscapular artery and the posterior circumflex humeral artery. The intermediate trunk branched off the anterior circumflex humeral artery as expected for an axillary artery. Second, in the other cadaver, we found a common trunk containing the thoracoacromial artery and a bulk artery dividing into three branches, the subscapular, posterior circumflex humeral, and lateral thoracic arteries. Taken together, we discuss the clinical implications and possible developmental origins of variations in the axillary artery branching and course.

Las variaciones arteriales en los miembros superiores pueden causar lesiones iatrogénicas al realizarse procedimientos invasivos. Durante una disección de rutina de los patrones de ramificación de la arteria axilar, se encontró una disposición aún no informada. En primer lugar, la segunda porción de la arteria axilar se presentó dividida en tres troncos. El tronco lateral se desplazó hacia abajo como una arteria braquiorradial superficial (arteria radial originándose de la arteria axilar). El tronco medial dio origen a la arteria torácica lateral, y se dividió en arteria subescapular y arteria circunfleja humeral posterior. El tronco intermedio dio origen a la arteria circunfleja humeral anterior como se espera para una arteria axilar. En un segundo cadáver, encontramos un tronco común entre la arteria toracoacromial y una arteria de mayor tamaño que se dividió en tres arterias: subescapular, circunfleja humeral posterior y torácica lateral. Consideradas estas variaciones arteriales en conjunto, se discuten las implicaciones clínicas y posibles orígenes del desarrollo de las variaciones en la ramificación de la arteria axilar y su trayecto.

An arterial island pattern of the axillary and brachial arteries: a case report with clinical implications.

The variability of axillary and brachial arteries is often associated with neural anomalies in arrangement of the brachial plexus. The current report is focused on the coexistence of two brachial arteries of axillary origin with an atypical median nerve formatted by three (two lateral and a medial) roots in the right arm of a 68-year-old male cadaver. Medially, the brachial artery located in front of the median nerve was named superficial brachial artery and anastomosed with the brachial artery situated posterolateral to the median nerve, hence it is referred as the main brachial artery or brachial artery. Subsequently, the two arteries were recombined and the created arterial complex, like an island pattern, ended dividing into radial and ulnar arteries, at the level of the radial neck. To our knowledge, the combination of the above-mentioned arterial pattern to an abnormally formatted median nerve has not yet been cited. The current neurovascular abnormalities followed by an embryological explanation may have clinical implications.

A radial artery originating from the thoracoacromial artery.

PURPOSE: The purpose of this case report is to report a rare vascular variation in the upper limbs because of its clinical importance and embryological implication. METHODS: During the educational dissection of a 73-year-old Korean male cadaver`s right upper limb, we found a variant branch which is originated from the thoracoacromial artery. RESULTS: The variant branch from the thoracoacromial artery ran to the distal forearm in the deep fascia. Because it finally coursed like the radial artery in the forearm and the palm, we defined the variant artery as superficial brachioradial artery (SBRA). In the cubital region a little below the intercondylar line, the brachial artery gave off a small communicating branch to SBRA, and continued as the ulnar artery. CONCLUSIONS: We reported this unique variation and discussed its clinical and embryological implication.

Implicancias clínico-quirúrgicas del origen alto de la arteria radial / Clinical and surgical implications of the radial artery high origin

Las variaciones arteriales del miembro superior tienen su justificación en el origen embriológico. El nacimiento de la arteria radial por proximal a la interlínea articular del codo es una de las variaciones anatómicas más frecuentes y su importancia radica en el aumento de los procedimientos percutáneos sobre la arteria radial en cateterismos coronarios y en el cada vez más utilizado colgajo radial en las cirugías reconstructivas. Su trayecto superficial favorece los traumatismos y la posibilidad de confusión con las venas puede ocasionar la realización de inyecciones medicamentosas accidentales en estas arterias con sus graves consecuencias. El conocimiento de las variaciones arteriales del miembro superior, y en especial de la arteria radial presentada en esta investigación, es fundamental al momento de planear abordajes clínicos y quirúrgicos que los involucre.

The upper limb arterial variations are justified by the embryological origin of all the limb. The birth of the radial artery above the joint line of the elbow is one of the most frequent anomalies and its importance is increasing in percutaneous procedures on the radial artery, in coronary catheterizations and the increasingly used of the ra- dial flap in reconstructive surgery. Its superficial way favors injuries and the possibility of confusion with veins that can cause accidental drug performing injections in these arteries with serious consequences. Knowledge of arterial variations of the upper limb, especially the radial artery presented in this research, is essential when planning clinical and surgical approaches that involves them.

[Combined treatment of complicated forms of angiodysplasias in conditions of a multimodality hospital].

Presented herein is a case report dealing with successive combined treatment for arteriovenous malformation of the left part of the chest, macrofistular form complicated by necroses of the left thoracic portion with arrosive haemorrhage from the area of necrosis. The authors describe diagnosis of this disease, technical peculiarities of performing transcatheter endovascular occlusion and topical treatment of wounds, underlining difficulties of verifying the pathology concerned at the prehospital stage and prevention of complications. Particular emphasis in management of these patients is placed upon therapeutic decision-making. Radical excision of tissue practically completely consisting of dilated thin-walled vessels may result in massive perfuse haemorrhage and is often impossible. Selective exclusion of feeding arteries by endovascular methods frequently leads to formation of necroses, does not differ in radical nature because of the presence of multiple arteriovenous fistulas and requires regular follow up of the patient due to a possibility of relapse. The final therapeutic decision should be made in the context of a particular patient, since there are no versatile approaches to management of the pathology concerned.

Comment on conservative management of isolated dissection of the superior mesenteric artery

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A coincidental variation of the axillary artery: the brachioradial artery and the aberrant posterior humeral circumflex artery passing under the tendon of the latissimus dorsi muscle.

A case of anomalous terminal branching of the axillary artery was encountered and described in a left upper limb of a male cadaver. A series of 214 upper limbs of Caucasian race was dissected. A variant artery, stemming from the very end of the axillary artery followed a superficial course distally. It passed the cubital fossa, ran on the lateral side of the forearm as usual radial artery, crossed ventrally to the palm and terminated in the deep palmar arch. This vessel is a case of the brachioradial artery (incorrectly termed as the "radial artery with high origin"). Moreover, it was associated with another variation, concerning the aberrant posterior humeral circumflex artery passing under the tendon of the latissimus dorsi muscle. The anatomical knowledge of the axillary region is essential for radiodiagnostic, surgical and traumatologic procedures. The superficially located artery brings an elevated danger of heavy bleeding in all unexpected situations, its variant branching can cause problems in radial catheterization procedures and the anomalously coursing other arterial variant poses an elevated danger in surgical procedures concerning the surgical neck of humerus.

Variant origin of an arterial trunk from axillary artery continuing as profunda brachii artery--a unique arterial variation in the axilla and its clinical implications.

BACKGROUND: Axillary artery is known to show different variations mostly in its branching pattern. Similarly, the origin of profunda brachii is often encountered with abnormality. Therefore, when the vascular variations in the upper limb persist, mostly it is confined to its branching pattern followed by its variant origin. But, among all the reported variations of profunda brachii, its variant origin from the 3rd part of the axillary artery with common trunk for the branches of axillary artery is unique. CASE DETAILS: We report here an anomalous origin of profunda brachii as continuation of an arterial trunk arising from 3rd part of the axillary artery. This common trunk at its commencement passed between 2 roots of median nerve and gave branches of 3rd part of axillary artery before it continued as profunda brachii artery. The further course and branching pattern of profunda brachii were normal. CONCLUSION: Since the axillary artery is next choice of artery for arterial cannulation in cardiopulmonary bypass procedures, prior knowledge of existence of such variation in its branching pattern helps in avoiding possible diagnostic or interventional therapeutic errors.

Bilateral arterial variation in the upper extremity--an anatomical case report.

We report a case of bilateral arterial variation in the upper extremities of a male cadaver. In the left upper extremity, it was observed that the ulnar artery was arising from axillary artery. This ulnar artery was superficial throughout its course at the medial aspect of the arm and forearm. It was highly tortuous and did not have any branches either in the arm or forearm. It ended as the superficial palmar arch in the palm. However the brachial artery entered the cubital fossa and divided into radial and common interosseus arteries. In contrast, the right upper extremity was having normal brachial artery which was terminated into the ulnar and radial arteries at the cubital fossa. However, there was an accessory brachial artery present at the arm and ended at the cubital fossa. We believe that these anatomical variations are because of abnormal developmental vascular pattern in the region. In clinical practice, accurate knowledge of the arterial variations of upper extremity is of considerable importance in case of reparative surgeries and fracture management. They are of interest to the vascular and plastic surgeons.

Clinico-embryological submission of an unilateral anomalous presentation of axillary artery.

OBJECTIVES: Descriptions of the variant arterial pattern of upper limb are not exceptional and are therefore frequently reported in anatomy archives. BACKGROUND: A noteworthy deviation from the usual branching pattern was observed unilaterally in a single cadaver. This unique division of axillary artery (AA) was present on the right side in an adult human cadaver of Indian origin. RESULTS: The first part of axillary artery gave off the superior thoracic and thoraco-acromial arteries. Just proximal to the upper border of pectoralis minor the AA was observed to divide into two trunks a medial and a lateral. The lateral trunk continued into the brachium as the usual axillary artery where as the medial trunk displayed the other branches deep and distal to the pectoralis minor muscle. The remarkable feature was the wide caliber of the axillary artery where it bifurcated into two branches. An attempt has been made to dwell upon the embryological basis of the present anomaly. CONCLUSIONS: The relevance of anomalous arterial pattern of upper limb (U.L.) is realized while performing percutaneous arterial venous catheter insertion into subclavian vein via the infraclavicular route. We advocate a meticulous familiarization of the anatomy of axillary artery and its topographical relationship to other neurovascular structures for the operating plastic surgeon, anesthetist and radiologist (Fig. 1, Ref. 12).