Multiple arterial variations in the upper limb: description and clinical relevance
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CASE REPORT
Multiple arterial variations in the upper limb: description and clinical relevance João Gabriel Alexander1 · Juliana Hott de Fúcio Lizardo1 · Josemberg da Silva Baptista1 Received: 22 May 2020 / Accepted: 2 September 2020 © Japanese Association of Anatomists 2020
Abstract Although arterial variations in the upper limb are usually found during anatomical dissections and clinical practice, multiple arterial variations associated with nervous variations along the limb is rare and clinically relevant. This paper described a combined anatomical variation involving the neurovasculature in the upper limb. A left upper limb dissection of a male cadaver with approximately 50–60 years of age, fixed in 10% formalin, was performed. During the dissection was observed, the brachial artery ending in the middle third of the arm in three branches: a nutritional branch for the biceps brachii muscle, a “lateral brachial artery” and a “medial brachial artery”, which became, after unusual paths crossing over the cubital fossa, the ulnar artery and the radial artery, respectively. Radial and ulnar artery demonstrated several unusual anastomotic branches, respectively, and an anastomotic arch around the biceps brachii muscle tendon. Such combined anatomical variation is unique and relevant for clinical and surgical practice. Keywords Brachial artery · Radial artery · Ulnar artery · Upper extremity · Anatomic variation
Introduction Variations in the arterial pattern of the upper limb (UL) are common findings during anatomical dissection and in clinical practice (Lippert and Pabst 1985; Bergman et al. 2006; Standring 2015; Tubbs et al. 2016), occurring in up to 20% of adult UL (Rodríguez-Niedenführ et al. 2001b). Among these variations, some are related to the branching pattern of the brachial artery (BA), such as an accessory brachial artery, bifurcation, and trifurcation (Standring 2015). Knowing both muscular and neurovascular variations of the UL is relevant for surgeons and radiologists to avoid diagnostic errors and iatrogenic lesions (Chakravarthi 2012). Although several works have been documenting these variations, the occurrence of multiple variations is rare and clinically relevant. This paper aims to describe a combined anatomical variation involving the BA, median nerve (MN), musculocutaneous nerve (MCN), radial artery (RA),
* Josemberg da Silva Baptista [email protected] 1
Laboratory of Applied Morphology (LEMA), Universidade Federal Do Espirito Santo, Marechal Campos, 1468 Maruipe, Vitoria, Espirito Santo 29043‑900, Brazil
ulnar artery (UA), and their anastomotic branches and topographies.
Materials and methods A left UL dissection of a male cadaver with approximately 50–60 years of age, fixed in 10% formalin, from the Universidade Federal do Espirito Santo collection, was performed at Laboratory of Applied Morphology. The body was donated by the Coroner’s Department of Espirito Santo through the law (Lei 8.501/1992). The limb was previously disarticulated from the body in the shoulder. A laye
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