Median artery persistence in coexistence with a bifid median nerve and interconnections of the median with the ulnar nerve and vice versa

Abstract

Purpose This report describes a bilateral persistent median artery (PMA) originating from the ulnar artery and terminating at different levels of the upper limb. The PMA coexisted with a bilateral bifid median nerve (MN) and two bilateral interconnections (ICs characterized with the symbol -) of the MN with the ulnar nerve (UN) (MN-UN) and a unilateral reverse IC (UN-MN). Emphasis was given to the artery’s developmental background. Methods The PMA was identified in an 80-year-old formalin-embalmed donated male cadaver. Results The right-sided PMA terminated at the wrist, posterior to the palmar aponeurosis. Two neural ICs were identified: the UN joined the MN deep branch (UN-MN), at the forearm’s upper third, and the MN deep stem joined the UN palmar branch (MN-UN), at the lower third (9.7 cm distally to the 1st IC). The left-sided PMA ended in the palm giving off the 3rd and 4th proper palmar digital arteries. An incomplete superficial palmar arch was identified by the contribution of the PMA, radial, and ulnar arteries. After the MN bifurcation into superficial and deep branches, the deep branches formed a loop, that was penetrated by the PMA. The MN deep branch communicated with the UN palmar branch (MN-UN). Conclusions The PMA should be evaluated as a causative factor of carpal tunnel syndrome. The modified Allen's test and the Doppler ultrasound may detect the arterial flow and the angiography may depict the vessel thrombosis in complex cases. PMA could also be a "salvage" vessel for the hand supply, in radial and ulnar artery trauma.

Thrombosed Persistent Median Artery with Coexisting Bifid Median Nerve in a Robotic Arthroplasty Surgeon

“…They terminate either proximal to the wrist or distally in the form of complete or incomplete SPAs 2-4,49-51 . PMAs can rarely coexist with other neurovascular anomalies such as a BMN 6-12 .…”

“…However, it may occasionally persist into adulthood 4,5 . Rarely, PMAs have been found to coexist with a bifid median nerve (BMN) [6][7][8][9][10][11][12] . The presence of a persistent median artery (PMA) has been reported to be associated with the occurrence of compression neuropathy 2,3,5,[13][14][15] -caused directly or secondary to associated pathology of the PMA including calcification, atherosclerosis, and thrombosis [16][17][18][19][20][21][22][23][24] .…”