The persistent median artery and its vascular patterns: A meta‐analysis of 10,394 subjects

Abstract

The presence of a persistent median artery (PMA) has been implicated in the development of compression neuropathies and surgical complications. Due to the large variability in the prevalence of the PMA and its subtypes in the literature, more awareness of its anatomy is needed. The aim of our meta-analysis was to find the pooled prevalence of the antebrachial and palmar persistent median arteries. An extensive search through the major databases was performed to identify all articles and references matching our inclusion criteria. The extracted data included methods of investigation, prevalence of the PMA, anatomical subtype (antebrachial, palmar), side, sex, laterality, and ethnicity. A total of 64 studies (n = 10,394 hands) were included in this meta-analysis. An antebrachial pattern was revealed to be more prevalent than a palmar pattern (34.0% vs. 8.6%). A palmar PMA was reported in 2.6% of patients undergoing surgery for carpal tunnel syndrome when compared to cadaveric studies of adult patients in which the prevalence was 8.6%. Both patterns of PMA are prevalent in a considerable portion of the general population. As the estimated prevalence of the PMA was found to be significantly lower in patients undergoing surgery for carpal tunnel syndrome than those reported in cadaveric studies, its etiological contribution to carpal tunnel syndrome is questionable. Surgeons operating on the forearm and carpal tunnel should understand the anatomy and surgical implications of the PMA and its anatomical patterns.

The Critical Appraisal Tool for Anatomical Meta‐analysis: A framework for critically appraising anatomical meta‐analyses

“…In this article, we introduced the CATAM rubric and used it to critically appraise a recently published anatomical MA (Kacprzyk et al, 2020). There have been other anatomical MAs recently published (Aldabe et al, 2019; Bellier et al, 2020; Berthaume & Bull, 2021; Cheruiyot et al, 2021; Dreher et al, 2018; Graves et al, 2017; Harvie et al, 2019; Koziej et al, 2020; Morelli et al, 2019; Nallikuzhy et al, 2018; Roberts et al, 2021; Sirico et al, 2019; Solewski et al, 2021; Stefura et al, 2018; Tomaszewska et al, 2018; Tomaszewska et al, 2018; Tomaszewski et al, 2017; Tomaszewski et al, 2017; Vikse et al, 2016a, 2016b; Whitley et al, 2020; Yammine, 2013, 2014b, 2014c, 2014d; Yammine et al, 2015; Yurasakpong et al, 2021). We believe that the running paper that we used is an exemplary anatomical MA (Kacprzyk et al, 2020).…”

Bifid median nerve as an anatomical risk factor for carpal tunnel syndrome: A meta‐analysis

“…Sugimoto et al (1994) explained that the PMA provides more sustainable blood perfusion to the MN than its "normal" vascularization patterns. Solewski et al (2021)…”

“…A PMA accompanies a BMN in many reports of CTS. Solewski et al (2021) conducted a meta‐analysis on the prevalence of PMAs and reported that the overall prevalence of palmar type PMA was 8.6% (95% CI: 6.7–10.8) and antebrachial type 34.0% (95% CI: 14.5–56.5). The antebrachial PMA is usually asymptomatic and detected during cadaveric dissection or radiological examination or surgery.…”

“…It usually regresses by the eighth week of gestation. Nevertheless, it can remain patent in the forearm (the antebrachial type of persistent median artery) or the palm near the superficial palmar arch (the palmar type of persistent median artery) (Solewski et al, 2021). Sometimes it pierces the nerve bundle and lies in perineurium, which separates into two or three bundles, that is, undergoes bifurcation or trifurcation (bifid or trifid median nerve) (Al‐Qattan et al, 2009; Corte et al, 2021).…”

A Unique Branching Pattern of the Brachial Artery: Coexisting Superficial Ulnar Artery and Persistent Median Artery

“…The antebrachial type is a delicate remnant of a partial regression of the median artery that terminates proximal to the wrist in the antebrachium while serving as the primary blood supply to the median nerve [5]. Previous reports indicate a PMA prevalence of 4.2%-6.6% with the antebrachial PMA making up nearly 75% of those cases [3][4][5][6][7][8][9][10][11].…”