Accessory brachial artery: a case report, embryological background and clinical relevance

Abstract

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.

An unusual high bifurcation and variable branching of the axillary artery in a Greek male cadaver

“…In our case, similarly to Maraspin ( 1971 ), Rao et al ( 2012 ) and Yotova & Novakov ( 2004 ), a high division of the 2 nd part of the AA into SBA and DBA occurred. Other authors (Cavdar et al 2000 ; Desai et al 2011 ; Kachlik et al 2011 ; Patnaik et al 2001 ; VijayaBhaskar et al 2006 ) found the AA bifurcation at the 3 rd part, while a rare bifurcation at the 1 st part, absence of the SSA and origin of the ATA from the DBA, was also referred (Jurjus et al 1999 ). In our case, unlike to Jurjus et al ( 1999 ), the DBA was larger than the SBA and the latter bifurcated into radial and ulnar arteries as usual, while in other studies, the SBA ended in the arm or continued as radial (high origin of radial) (Cavdar et al 2000 ; Keen 1961 ; Natsis et al 2009 ; Rodriguez-Niedenfuhr et al 2001 ) or ulnar artery (high origin of ulnar) with both arteries coursing superficially (Keen 1961 ; Natsis et al 2006a ; Rodriguez-Niedenfuhr et al 2001 ).…”

“…Trotter et al ( 1930 ) found no racial differences. A unique case of AA trifurcation into SBA, PBA and SSA was also reported (Kachlik et al 2011 ). The SBA, especially the height of its emersion from the AA gathers the greatest interest.…”

“…The SBA, especially the height of its emersion from the AA gathers the greatest interest. Recently, Kachlik et al ( 2011 ), Patnaik ( 2000 ) and Yang et al ( 2008 ) mentioned the unilateral presence of the SBA in 5–12.2%, while Jurjus et al ( 1999 ) and Yang et al ( 2008 ) described sporadic cases of bilateral occurrence. The presence of the SBA is more frequent in males and on the right side (Rodriguez-Niedenfuhr et al 2001 ).…”

Anatomical Variations of Brachial Artery - Its Morphology, Embryogenesis and Clinical Implications

“…Kachlik et al, reported accessory brachial artery emerging from the third part of axillary artery and its reunion with the main brachial artery in the cubital fossa [14]. Yoshinaga et al, reported bifurcation of brachial artery into large superficial and small deep branches at the lower border of teres major muscle [15].…”

A Typical Branching Pattern of Axillary Artery in a South Indian Cadaver ? A Case Report

“…It begins at the outer border of the first rib and ends at the level of the lower border of the teres major muscle as a brachial artery Susan [1]. Brachial artery variations are not uncommon; Kachlik [2] reported the origin of accessory brachial artery from the axillary artery which had joined the main brachial artery in the lower part of the arm [2]. Superficial brachial artery was reported by Al-Fayez et al [3].…”