A Rare Pattern of Brachial Artery Variation: Case Report

Abstract

SUMMARY:Unlike the venous system, variations in arterial anatomy are less frequent and most of them affect visceral arteries. In limbs, variations of the brachial artery are the most reported and at least six different patterns have been described so far. The commonest is the superficial brachial artery which lies superficially to the median nerve. Much less prevalent are the high origin of the radial artery (brachioradial artery) or the existence of a doubled brachial artery (accessory brachial artery). We present a previously undescribed pattern of brachial artery variation. During dissection of the right upper limb of a 60 year-old male embalmed cadaver, we found the bifurcation of the brachial artery in the proximal portion of the middle third of the arm. Its medial branch reaches the medial aspect of the arm, posterior to the median nerve. Afterwards, this medial branch redirects laterally and crosses again the median nerve, this time lying anterior to the nerve until it reaches the lateral aspect of the arm. At the elbow level, the medial branch originates the radial artery. The lateral branch of the brachial artery remains lateral to the median nerve and continues as ulnar artery and originates the interosseus artery.

Anomalies of radial and ulnar arteries

“…A brachial artery dividing into a lateral branch that continued as a radial artery and a medial branch continuing as an ulnar artery has also been described. 7 However, our case differs in that the radial artery was located medially and the ulnar artery laterally. Also, in our case the brachial artery bifurcated in the upper part of the arm, while in the above case it bifurcated in the middle of the arm.…”

Assessment of anatomic variations of the brachial artery bifurcation using vascular Doppler ultrasound: a cross-sectional study

“…The name given to the accessory brachial artery in the forearm depends on its course, and it can be termed brachioradial, brachioulnar, superficial brachioulnar, brachio-interosseous, brachio-ulnoradial, or even brachio-median, 8 the last of which follows the course of the median nerve. 9 Trifurcation of the brachial artery is also possible, as reported by Jacomo et al, 10 giving rise to radial, ulnar, and collateral superficial ulnar arteries. 10 According to Devisankar et al, 11 the connection between the accessory brachial artery and the arteries of the forearm can be called an aberrant vessel.…”

“…9 Trifurcation of the brachial artery is also possible, as reported by Jacomo et al, 10 giving rise to radial, ulnar, and collateral superficial ulnar arteries. 10 According to Devisankar et al, 11 the connection between the accessory brachial artery and the arteries of the forearm can be called an aberrant vessel. According to Elnaiem et al, 7 in the majority of cases the accessory brachial artery continues in the forearm as a collateral superficial ulnar artery, which contributes to formation of the superficial and deep palmar arches.…”

“…Moreover, it can also contribute to collateral circulation in the event of occlusion of the principal brachial artery. 10 , 24 …”

Unilateral accessory brachial artery: A case report with embryological background and review of the literature

“…Then, it passes distally along the ventral surface of the arm to end in the cubital fossa by dividing into ulnar and radial arteries. Brachial artery variations were reported in 20% of the cases [ 4 ]. The accessory brachial artery is an upper limb arterial variation that presents in 0.1%–0.8% of the population.…”