Background: The accessory brachial artery (arteria brachialis accessoria) is a rare upper limb vascular abnormality, reported in less than one percent of cases. It is the artery originating from the axillary artery or the brachial artery, which rejoins the brachial artery further along its distal course within the arm or cubital fossa. Its detailed knowledge is necessary in transradial transulnar catheterization during coronary procedures, mainly due to its narrow caliber, which is responsible for the failure of the intervention performance. Objectives: Present a case of uncharacteristic branching pattern of the accessory brachial artery. Method: The case was observed during a routine dissection in the left axilla of a female cadaver at the Department of Anatomy at the Third Faculty of Medicine, Charles University in Prague. Results: The infrapectoral part of the axillary artery gave rise to a branch that descended distally along the medial side of the arm. This artery accompanied firstly the ulnar nerve, then it diverted laterally towards the median nerve and coursed hidden behind it to re-enter the brachial artery within the distal part of the arm, next to the biceps brachii muscle. The calibre of the accessory brachial artery was two mm only. Conclusion: The accessory brachial artery is a rare variant of the upper limb vascular system and its prevailingly narrow lumen can cause a failure of the transradial/transulnar catheterization intervention.

Although the variability of the upper limb arteries is a clinically important problem, the prevalence varies across the existing studies and the classification is rather complicated, uncoined, and sometimes even unclear for its simple and direct understanding and usage. Multiple case reports appearing in the last years apply incorrect, inappropriate, and sometimes misleading terminology. Here we performed an anatomical cadaveric study of the variability of the arteries of the upper limb, namely the axilla, arm and forearm, in 423 upper limbs (Central European population) embalmed with the classical formaldehyde method. We proposed the application of the Equality system based on common trunks for denomination of the axillary artery branches principal variations: truncus subscapulocircumflexus (22.9%), truncus profundocircumflexus (13.75%), and truncus bicircumflexus (13.95%). Further, we proposed the terminology system developed by Rodríguez-Niedenführ et al. for the free upper limb principal arterial trunk variations based on the origin, location (in the arm only or in the arm and forearm), and course (related to the forearm flexor muscles) of the involved artery: arteria brachialis superficialis (9.5%), arteria brachioradialis superficialis (6.4%), arteria brachioulnaris superficialis (1.9%), arteria brachiomediana superficialis (0.5%), and arteria comitans nervi mediani manus (3.3%). Extensive development of the catheterisation methods via the arteria radialis et ulnaris as well as surgical procedures using flaps based on perforating branches of these arteries (including arteria brachioradialis superficialis et brachioulnaris superficialis) necessitate thorough data on the prevalence of the variant vessels for safe performance of these procedures and to prevent any unexpected situations or to react adequately when they occur.

Th e aim of the study was to evaluate the terminal segmentation of the axillary artery and to present four cases of anomalous branching of the axillary artery, the superfi cial brachial artery (arteria brachialis superfi cialis), which is defi ned as the brachial artery that runs superfi cially to the median nerve. Totally,  cadaveric upper arms embalmed by classical formaldehyde technique from collections of the Department of Anatomy, Th ird Faculty of Medicine, Charles University in Prague, were macroscopically dissected with special focus on the branching arrangement of the axillary artery. Th e most distal part of the axillary artery (infrapectoral part) terminated in four cases as a bifurcation into two terminal branches: the superfi cial brachial artery and profunda brachii artery, denominated according to their relation to the median nerve. Th e profunda brachii artery primarily gave rise to the main branches of the infrapectoral part of the axillary artery. Th e superfi cial brachial artery descended to the cubital fossa where it assumed the usual course of the brachial artery in two cases and in the other two cases its branches (the radial and ulnar arteries) passed superfi cially to the fl exors. Th e incidence of the superfi cial brachial artery in our study was  of cases. Th e reported incidence is a bit contradictory, from . to  of cases. Th e anatomical knowledge of the axillary region is of crucial importance for neurosurgeons and specialists using the radiodiagnostic techniques, particularly in cases involving traumatic injuries. Th e improved knowledge would allow more accurate diagnostic interpretations and surgical treatment.

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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.