High Brachial Artery Bifurcation: Clinical Considerations and Practical Implications for an Arteriovenous Access

Abstract

High brachial artery bifurcation (HiBAB) is not a rare occurrence. Recent data have emphasized that HiBAB can have major clinical implications including high failure rate and decreased functional patency of an arteriovenous (AV) fistula. In this retrospective study, we investigated the incidence of HiBAB. Patients with advanced chronic kidney disease and end-stage renal disease on chronic hemodialysis undergoing preoperative vascular mapping for the creation of an AV access were included in this analysis. Ultrasound examination was used to map the arteries of the upper extremities. Four hundred and eighty-one arms in 340 patients were examined (right arm = 181, left arm = 300). Sixty-nine of the 481 (12.3%) demonstrated HiBAB. The internal diameter of the radial and ulnar arteries measured at the elbow region was found to be 2.9 ± 0.8 and 3.6 ± 1.0 mm, respectively (p = 0.0001). There were no statistically significant differences in terms of race, gender, and right versus left arms regarding the incidence of HiBAB. As HiBAB can be present in a significant number of patients and have an impact on the AV access, its presence should be evaluated during vascular mapping prior to an AV access creation.

Morphological feature of brachial artery and its clinical significance

“…Based on ultrasound study, the success rate of artificial arteriorvenous fistula for hemodialysis purpose is increased as the internal diameter of artery is more than 0.16 mm (KIAN, SHAPIRO, SALMAN et al, 2012). Therefore, the main findings of present study are relatively focused on morphology including the external and internal diameter as well as wall thickness of the proximal, middle and distal part of brachial artery.…”

“…Also, the bifurcation of the brachial artery occurred proximal to interchondyler line referred as a high division in which has been reported in series studies (MOORE and PERSAUD, 1999;CELIK, GÖRMÜS, ALDUR, et al, 2001;PATNAIK, KALSEY and SINGLA, 2001;QUARRAT, KAUSER and RAZA, 2002;CHERUKUPALLI, DWIVEDI and DAYAL, 2008;SATHYNARAYAN, SUNITHA, SHAIK et al, 2010;SINGH, GUPTA, BARGOTRA et al, 2010). The high brachial artery bifurcation is most common vascular variation of the upper limb (MCCORMACK, CAULDWELL and ANSON, 1953;RODRIGUEZ-NIEDENFUHR, VAZQUEZ, NEARN et al, 2001) which occurs in 12.3% (KIAN, SHAPIRO, SALMAN et al, 2012) or 10% (AL-SOWAYIGH, ZAKI, EL-HAGGAGY, et al, 2013). In present study, the brachial artery bifurcates into ulnar and radial arteries in different level distal to the superior margin of the head of the radius.…”

Variations of Musculocutaneous Nerve Combined with High Bifurcation of the Brachial Artery

“…Knowing that such artery variation is necessary to arterial cannula, inappropriate cannula can result in thrombosis, gangrene, and even limb loss [6]. Although high brachial artery bifurcation is not a rare occurrence [7], high bifurcation of the brachialartery coexisting with the multiple branches of the musculocutaneous nerve is rare to see.…”

Anatomical variations of the terminal branching of the brachial artery

“…It may bifurcate as high as the axillary artery, but most commonly it divides at the proximal 1/3 of the upper arm [4]. Recent studies have revealed that the high bifurcation can cause several clinical implications including increased failure rate of AV fistulae created for hemodialysis [3].…”