A rare variant of the ulnar artery with important clinical implications: a case report

Abstract

BackgroundVariations in the major arteries of the upper limb are estimated to be present in up to one fifth of people, and may have significant clinical implications.Case presentationDuring routine cadaveric dissection of a 69-year-old fresh female cadaver, a superficial brachioulnar artery with an aberrant path was found bilaterally. The superficial brachioulnar artery originated at midarm level from the brachial artery, pierced the brachial fascia immediately proximal to the elbow, crossed superficial to the muscles that originated from the medial epicondyle, and ran over the pronator teres muscle in a doubling of the antebrachial fascia. It then dipped into the forearm fascia, in the gap between the flexor carpi radialis and the palmaris longus. Subsequently, it ran deep to the palmaris longus muscle belly, and superficially to the flexor digitorum superficialis muscle, reaching the gap between the latter and the flexor carpi ulnaris muscle, where it assumed is usual position lateral to the ulnar nerve.ConclusionAs far as the authors could determine, this variant of the superficial brachioulnar artery has only been described twice before in the literature. The existence of such a variant is of particular clinical significance, as these arteries are more susceptible to trauma, and can be easily confused with superficial veins during medical and surgical procedures, potentially leading to iatrogenic distal limb ischemia.

Superficial brachioulnar artery and its clinical significance

“…By stage 18, the radial artery begins its development more proximal to the ulnar artery, later regressing and establishing its final attachment near the ulnar artery around the cubital fossa [8]. Variations in upper extremity vasculature are thought to be due to failures in persistence, enlargement, and differentiation of early capillary networks which would otherwise remain as capillaries or regress [4]. The high bifurcation of the brachial artery is likely the result of unusual induction and branching of primitive vascular plexuses [9].…”

“…In this case, the vascular variations caused an atypical arrangement with the median nerve coursing between radial and ulnar arteries. Preoperative angiogram in flap surgery may help to trace the course of a variant artery and discover its site of origin [4]. The vascular variations are often accompanied by nervous and muscular variations of the upper limb [13], but this particular case revealed isolated arterial variations.…”

“…Anatomical variations in this branching pattern have been well documented; however, the majority of these variations occur in the radial artery [2] followed by the ulnar artery, with only around 2.26% exhibiting a superficial brachioulnar artery (SBUA) variation [34]. SBUA is defined as an ulnar artery with a high origin coursing over the forearm flexor muscles, but deep to the brachial fascia [245]. The bilateral SBUA with a variant relation to the forearm muscles as found in this case is rarely reported in the literature [3].…”

High origin of the radial artery (superficial brachialarterial artery):Presentation of 3 cases

“…Estas arterias pueden dar un número variable de colaterales o carecer de estas (20)(21)(22)(23). El origen alto de la arteria radial es la variación más frecuentemente encontrada, descubriéndose por disección cadavérica en el 14 al 19,5 % y por arteriografías en el 9,75 % (7,24), mientras que el origen alto de la arteria cubital se da en el 2 % (25).…”

Arteria Ulnar Superficial, Bilateral y Antebraquial. Similitudes y Diferencias

“…El origen de la AUS ha sido reportado en la arteria axilar (AA) (Dubreuil Chambardel, 1926;Singer, 1933;Weathersby, 1956;Fadel & Amonoo-Kuofi, 1996;Jacquemin et al, 2001;Natsis et al, 2006;Mannan et al, 2008;Yadav et al, 2013); en la arteria braquial (AB) en el brazo (Hazlett, 1949;Weathersby;Blagojka, 1982;del Sol et al, 2000;Rodríguez-Niedenführ et al, 2001;Natsis et al;Dartnell et al, 2007;Senanayake et al, 2007;Troupis et al, 2011;Casal et al, 2012;Solan, 2013;Salunke et al, 2014;Abhinita et al, 2016) o en la fosa cubital (Hazlet; Weathersby;Blagojka;Panicker et al, 2003;Shetty et al, 2013;Yadav et al;Kusztal et al, 2014;Kumka & Purkiss, 2015;Quadros et al, 2015;Sirasanagandla et al, 2016). En nuestro caso, los hallazgos remiten a este último origen y al trayecto en el antebrazo de ambas arterias.…”