Output Relations of Humeral Circumflex Arteries and its Variations

Abstract

SUMMARY: A large range of variability marks the branching pattern of the axillary artery. The knowledge of the anatomical variations and this pattern is essential to diagnostic and therapeutic approaches, including surgery, of the axillary region. The aim of this study was to observe the different possible origins of circumflex humeral arteries and to measure the length and diameter of each vessel. In our study, 24 armpits from adult cadavers (fixed in tamponed formalin 10%) were dissected. The data were analyzed with a digital caliper and the results expressed as Mean ± SD. In majority of specimens, posterior circumflex humeral artery (PCHA) arose from subscapular artery (SSA) (54.16%) and had an average diameter of 3.92±0.41 mm. The anterior circumflex humeral artery was a branch from axillary artery (AA) in the majority of the specimens (62.5%) with an average diameter of 1.83±0.68 mm. Circumflex humeral arteries can arise from SSA, deep brachial artery and AA. The result of this study is an interesting data for origin, length and diameter of these vessels, contributing to the knowledge of these variations occurrence.

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“…The ACHA commonly arises from the axillary artery as a single branch (Boesmueller et al, 2014 ; Chen et al, 2014 ; Duparc et al, 2001 ; Fontes et al, 2015 ; Hettrich et al, 2010 ; Kasai et al, 1984 ; Keough et al, 2019 ; Meyer et al, 2005 ). However, several studies have highlighted variations.…”

“…However, several studies have highlighted variations. Common variations include an origin from a common trunk together with the PCHA (Boesmueller et al, 2014 ; Chen et al, 2014 ; Duparc et al, 2001 ; Fontes et al, 2015 ; Hettrich et al, 2010 ; Kasai et al, 1984 ; Keough et al, 2019 ; Meyer et al, 2005 ) or as a branch of the subscapular artery (Fontes et al, 2015 ; Keough et al, 2019 ). Fontes et al, ( 2015 ) observed one case where the ACHA stemmed from the profunda brachii artery.…”

“…Common variations include an origin from a common trunk together with the PCHA (Boesmueller et al, 2014 ; Chen et al, 2014 ; Duparc et al, 2001 ; Fontes et al, 2015 ; Hettrich et al, 2010 ; Kasai et al, 1984 ; Keough et al, 2019 ; Meyer et al, 2005 ) or as a branch of the subscapular artery (Fontes et al, 2015 ; Keough et al, 2019 ). Fontes et al, ( 2015 ) observed one case where the ACHA stemmed from the profunda brachii artery. The ACHA then continues laterally, in a relatively horizontal course, deep to coracobrachialis and the short head of biceps (Kasai et al, 1984 ; Menck et al, 1997 ) towards the long head of biceps tendon located in the intertubercular groove (Figure 1 ).…”

“…The PCHA most commonly originates as a single branch from the axillary artery (Chen et al, 2014 ; Duparc et al, 2001 ; Fontes et al, 2015 ; Keough et al, 2019 ; Menck et al, 1997 ) and less commonly from a common trunk shared with the ACHA, or collectively from the subscapular artery (Chen et al, 2014 ; Fontes et al, 2015 ; Kasai et al, 1984 ; Keough et al, 2019 ; Menck et al, 1997 ; Meyer et al, 2005 ). Some less common origins have also been reported, such as from the profunda brachii artery (Chen et al, 2014 ; Duparc et al, 2001 ; Fontes et al, 2015 ; Kasai et al, 1984 ), the lateral thoracic artery (Meyer et al, 2005 ) or from the brachial artery (Meyer et al, 2005 ). Together with the axillary nerve, the PCHA travels through the quadrangular space towards the posterior shoulder.…”

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Many studies have investigated the blood supply of the humeral head, and amongst these, several contradictions and inconsistences exist.Understanding and being aware of vascular anatomy and its variations is clinically relevant for several reasons: for surgeons repairing proximal humeral fractures in order to assess the vascular injury, for physicians performing diagnostic or therapeutic procedures using angiograms of these vessels and potentially also for those inclined to develop new surgical techniques (Fontes et al, 2015;Hettrich et al, 2010).

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