Prevalence of the Persistant Median Artery

Abstract

Introduction: Neurovascular variations in the upper limb are common and they are well documented. An accurate knowledge of the normal and the variant anatomy of the median nerve and the median artery are important for clinical procedures and for vascular surgeries. The persistant median artery is one such anomaly which was seen in 6.6% (4) of the 60 upper limbs which were dissected in the present study, it being bilateral in one cadaver. Material and Methods:The present study was conducted on 60 upper limbs of 30 cadavers at the Government Medical College, Amritsar, India. The whole course of the median nerve and the persistant median artery was exposed. Results:In all the 4 variant limbs, the persistent median artery originated from the anterior interrosseous artery and terminated in the incomplete mediano-ulnar type of the superficial palmar arch. In three upper limbs, the persistant median artery simply accompanied the median nerve upto the palm. But in the left upper limb of the cadaver with the bilateral variation, the artery penetrated and divided the nerve into two halves which joined to form a neural loop around the artery. Thereafter, the nerve and the artery followed the same course upto the palm. Such a penetration of the median nerve by the persistent median artery is extremely rare. Further, its ontogeny and clinical implications have been discussed in detail.

Persistent Median Artery as an Unusual Finding in the Carpal Tunnel: Its Contribution to the Blood Supply of the Hand and Clinical Significance

“…This statement is consistent with our study results which revealed that the PMA in the carpal tunnel could occupy an anterior, anterolateral, or even an anteromedial position. The PMA could also occur alongside one of the most common variations of the median nerve, a bifid median nerve [35,36]. If the median nerve is bifid, the PMA could be located between the 2 nerve bundles, as observed in 2 cases in our study.…”

“…Coexistence of PMA and muscular variations has also been reported. Singla et al [36] described a case in which the PMA penetrated and divided the median nerve into 2 halves which joined to form a neural loop around the artery. Kachlik et al [34] found coincidence of superficial brachiomedian artery and bitendinous palmaris longus muscle.…”

“…According to the authors, diagnostic neuromuscular ultrasound and consideration of an anatomical variation involving the median nerve might be crucial to the differential diagnosis of various clinical syndromes. According to Singla et al [36], an anomalous PMA which penetrates the median nerve might compress it and produce symptoms of proximal median neuropathy, which might be similar to those caused by the Struthers ligament or a tight bicipital aponeurosis. Moreover, the compressive force of the pulsating artery which pierces the nerve might produce ischemia in the nerve [36].…”

“…According to Singla et al [36], an anomalous PMA which penetrates the median nerve might compress it and produce symptoms of proximal median neuropathy, which might be similar to those caused by the Struthers ligament or a tight bicipital aponeurosis. Moreover, the compressive force of the pulsating artery which pierces the nerve might produce ischemia in the nerve [36]. Compressed nerves are usually weak at the site of the arterial penetration and more susceptible to influence of other pathological conditions such as diabetes mellitus [36,43].…”

Brachiomedian artery (arteria brachiomediana) revisited: a comprehensive review

“…Table 1 summarizes the most important studies of over 100 specimens (available to the authors) to see the incidence range. For other detailed data [ 9 , 10 ].…”