For citation purposes: Pokhrel R, Bhatnagar R. Unilateral High Bifurcation of Brachial Artery. OA Anatomy 2013 Dec 01;1(4):34.

Case report

 
Gross Anatomy

Unilateral high bifurcation of brachial artery

R Pokhrel*, R Bhatnagar
 

Authors affiliations

Department of Anatomy, Armed Forces Medical College, Pune 40, India

* Corresponding author Email: rongon28us@yahoo.com

Abstract

Introduction

Brachial artery, the principal artery of the arm, usually divides at the level of neck of radius into two branches. This article reports a case of unilateral high bifurcation of the brachial artery.

Case report

We report a case of high division of the brachial artery at the level of insertion of the coracobrachialis muscle. Further course of the ulnar and radial artery after reaching the forearm was usual.

Discussion

This variation, though not very uncommon, occurs in the embryo due to persistence of the upper portion of the radial artery arising from the brachial artery proximal to the origin of the ulnar artery followed by failure of development of the new connection of the radial artery with the brachial artery at the level of origin of the ulnar artery.

Conclusion

High division of the brachial artery has a profound applied importance especially in the field of vascular surgery and radiology, and the possibility of this variation should be bore in mind before any vascular surgery in the region of the forearm or while interpreting arteriograms of the upper limb.

Introduction

The brachial artery usually begins as a continuation of the axillary artery at the distal border of tendon of teres major and ends at about a centimetre distal to the elbow joint at the level of neck of radius by dividing into radial and ulnar arteries[1]. Variations in arterial patterns of the upper limb in adult human bodies have been frequently observed either in routine dissections or in clinical practice[2]. A case of such a variation with its embryological basis and clinical significance is presented and discussed.

Case report

During routine dissection for medical undergraduates at our institute, an unusually high origin of radial artery, that is brachioradial artery[3], was observed in the left arm of an adult male cadaver of approximately 60 years of age. The radial artery arose at the level of insertion of the coracobrachialis muscle (Figures 1 and 2). Profunda brachii, superior collateral and inferior collateral arteries arose from the brachial artery after the origin of radial artery (Figure 3). The brachial artery continued as ulnar artery in the forearm. Further course and branching patterns of the radial and ulnar arteries in the forearm and palm were usual. The right arm revealed no unusual vascular observations.

Radial artery arising at a higher level in the left arm. TM, teres major muscle; CBM, coracobrachialis muscle; PBA, profunda brachii artery; BA, brachial artery; SUCA, superior ulnar collateral artery; MN, median nerve.

Origin, branching of brachial artery and course of radial artery in the left forearm. AA, axillary artery; BA, brachial artery; BRA, brachioradial artery; RA, radial artery; UA, ulnar artery.

Usual branching of brachial artery just distal to elbow joint into radial and ulnar arteries in right arm. BA, brachial artery; RA, radial artery; UA, ulnar artery; RRA, recurrent radial artery.

Discussion

In the upper limb bud, the axis artery is derived from the lateral branch of the seventh intersegmental artery, that is subclavian artery (Figure 4). The proximal part of the main trunk of this artery forms axillary and brachial arteries and its distal part persists as anterior interosseous artery and deep palmer arch. Radial and ulnar arteries are last to appear in the forearm from the axis artery, that is brachial artery. Initially, the radial artery arises more proximally than the ulnar artery. Later, it establishes a new connection with the main trunk at or near the level of the ulnar artery. The upper portion of its original stem usually disappears to a large extent. Persistence of the upper portion of the radial artery arising from the brachial artery proximal to origin of the ulnar artery followed by failure of development of the new connection of the radial artery with the brachial artery at the level of origin of the ulnar artery causes this type of anomaly[4,5] (Figure 5).

Lateral branch of seventh intersegmental artery in embryo from wh-ich subclavian artery develops.

Schematic diagram of development of brachial artery showing the normal pattern (B) and variant as seen in our case (A). 1, brachial artery; 2, radial artery—initial connection; 3, ulnar artery; 4, radial artery—final connection; 5, anterior interosseous artery and 6, median artery.

Diagnostically, this variation may disturb the evaluation of arteriography images and can have serious implications in orthopaedic, plastic and vascular surgeries. Blood pressure, which is normally measured in the arm in the brachial artery, is also affected when there are double arteries instead of a single brachial artery.

Incidences of brachioradial artery in earlier studies are depicted in Table 1.

Table 1

Incidence of high origin of radial artery, that is brachioradial artery, as reported by earlier workers

There were no statistical differences in the sides, that is left or right, and sexes in any of these studies.

Conclusion

Variations in arterial pattern of the arm and forearm are not uncommon. These variations have an embryological basis and need to be taken into consideration while analysing arteriograms and planning surgeries in the upper extremity.

Authors contribution

All authors contributed to the conception, design, and preparation of the manuscript, as well as read and approved the final manuscript.

Competing interests

None declared.

Conflict of interests

None declared.

A.M.E

All authors abide by the Association for Medical Ethics (AME) ethical rules of disclosure.

References

  • 1. Standring S . Gray’s anatomy: The anatomical basis of clinical practice. 40th ed. London: Elsevier Churchill Livingstone 2008.
  • 2. Singh H, Gupta N, Bargotra RN, Singh NP. Higher bifurcation of brachial artery with superficial course of radial artery in forearm. JK Science 2010;1239-40.
  • 3. Rodríguex-Niedenfuhr M, Vázquez T, Nearn L, Ferreira B, Parkin I, Sańudo J. Variations of the arterial pattern in the upper limb revisited: a morphological and statistical study, with a review of the literature. J Anat 2001 Nov;199(5):547-66.
  • 4. Sunitha P, Satayanarayana N, Shaik M, Devi P. Brachial artery with high up division with its embryological basis and clinical significance. Int J Anatom Var 2010;358.
  • 5. Arey LB . Developmental anatomy. 6th ed. Philadelphia: WB Saunders 1957p375-77.
  • 6. Hollinshead WH . Anatomy for surgeons. Philadelphia: Harper & Row 1968p247-50.
Licensee to OAPL (UK) 2013. Creative Commons Attribution License (CC-BY)

Incidence of high origin of radial artery, that is brachioradial artery, as reported by earlier workers

S. No Author and year n BRA %r
1 Quain, 1844 429 53 12
2 Muller, 1903 300 41 13.7
3 Adachi, 1928 410 29 7
4 McCormack, 1953 750 107 14.3
5 Weathersby, 1956 408 64 15.6
6 Skopakoff, 1959 610 55 9
7 Keen, 1961 284 17 5.9
8 Wankoff ,1962 800 78 9.7
9 Rodriguez-Baeza, 1995 150 6 4
10 Rodriguez-Niedenfuhr, 2000 385 53 13.8

n, sample size; BRA, total incidence of brachioradial artery; %, incidence of brachioradial artery in percentage. Cited from Anatomy for Surgeons by Hollinshed6