Superficial brachioulnar artery and its clinical significance

Abstract

The authors report a rare variation of the vasculature in the upper limbs of an 84-year-old male cadaver. A high bifurcation of the brachial artery occurred bilaterally at the proximal one-third of each arm. The radial arteries were larger than the ulnar arteries and gave origin to the common interosseous arteries. At the cubital fossa, the ulnar arteries traversed medial to the median nerves, continuing superficial to all forearm muscles except the palmaris longus tendon, characteristic of superficial brachioulnar arteries. The aforementioned variations have rarely been reported in previous literature and demonstrate important clinical significance in relation to accidental intra-arterial injections, errors in blood pressure readings, as well as orthopedic, plastic, and vascular surgeries of the upper limbs.

High Bifurcation of the Brachial Artery: An Embryological Overview

“…Similar patterns have also been described by Lippert and Pabst and later studies [16,[20][21]. Sieger et al, in 2019, emphasized the importance of angioblasts in the vascular pathway and highlighted their role along with variable developmental hemodynamics in the emergence of unusual arterial patterns [17]. Abnormalities in this process of morphogenesis during the embryological life of the human embryo may result in a series of variations both concerning the origin and the course of the vessels of the upper limb [18][19].…”

“…The hemodynamic dominance determines the involution of the superficial parts of the arteries that are located near the anastomosis while the upper parts remain as part of the RA [15][16]. An unusual induction and branching of primitive vascular plexuses, lead by vascular growth factors (such as vascular endothelial growth factor) and developmental hemodynamics, may result in variations such as a high bifurcation of the brachial artery [17].…”

Study of course and termination of brachial artery by dissection and computed tomography angiography methods with clinical importance

“…The superficial brachioulnar artery in upper part of forearm can be explained on the basis of haemodynamic mechanism between deep and superficial arteries in the forearm. Change in the embryonic haemodynamics during angiogenic sprouting may result in primitive vasculature which persists or regresses in unusual patterns [33].…”

Superficial brachioulnar artery in man

“…The maturation, enlargement and remodelling of this initial capillary plexus extends in a proximal to distal sequence as the bud of upper limb grows, finally resulting in formation of a single vessel, called the axial artery [2-4, 23, 29]. The axial artery consecutively differentiates into its following four segments: subclavian and axillary arteries by stage 15, the brachial artery extending until the elbow by [23,27].…”

“…Formation of the subclavian artery indicates bilateral differences: the left subclavian artery is wholly derived from the left seventh intersegmental artery, while the right subclavian artery is a derivative of three arteries: the right fourth aortic arch, a segment of the right dorsal aorta and the right seventh intersegmental artery [27,30]. The axillary, brachial and anterior interosseous arteries traverse the shoulder, the arm and the forearm, respectively.…”