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CASE REPORT
Year : 2013  |  Volume : 16  |  Issue : 2  |  Page : 74-76

A case report of vasa aberrantia in the brachial artery: A clinically important variation


1 Department of Anatomy, Melaka Manipal Medical College, Manipal University, Manipal, India
2 Department of Orthopedics, Faculty of Medicine, AIMST University, Semeling, Bedong- 08100, Kedah, Malaysia

Date of Web Publication19-Jul-2013

Correspondence Address:
K G Mohandas Rao
Melaka Manipal Medical College (Manipal Campus), Manipal University, Manipal - 576 104
India
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DOI: 10.4103/1118-8561.115267

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  Abstract 

Arterial variations in the upper limb are common. These variations are of high clinical and surgical importance. In the right upper-limb of an approximately 60-year-old male cadaver, the brachial artery (BrA) gave an aberrant branch (AdBrA) on its medial side in the middle of the arm, which ran superficially along the basilic vein (BV) in the lower part of the arm. As it reached the roof of the cubital fossa, it ran downwards and laterally along the median cubital vein (MCV) superficial to the bicipital aponeurosis (BA). In the cubital fossa, this artery was joined by the lateral terminal branch (LTB) of BrA forming an arterial loop in front of tendon of biceps brachii. This arterial loop gave a larger branch which continued as radial artery (RA) and a smaller muscular artery. The surgical and clinical significance importance of the case is discussed and literature review is presented.

Keywords: Arterial loop, arterial variation, cubital fossa, intravenous injections, median cubital vein, Radial artery


How to cite this article:
Mohandas Rao K G, Rao AS, Nayak S, Kumar N, Kumar P V, Ashwini L S, Sapna M, Shetty SD. A case report of vasa aberrantia in the brachial artery: A clinically important variation. Sahel Med J 2013;16:74-6

How to cite this URL:
Mohandas Rao K G, Rao AS, Nayak S, Kumar N, Kumar P V, Ashwini L S, Sapna M, Shetty SD. A case report of vasa aberrantia in the brachial artery: A clinically important variation. Sahel Med J [serial online] 2013 [cited 2019 Oct 15];16:74-6. Available from: http://www.smjonline.org/text.asp?2013/16/2/74/115267


  Introduction Top


Arterial variations in the upper limb are common. Yet, their thorough knowledge is very essential for the clinicians, radiologists and surgeons. Normally, brachial artery (BrA) gives profunda brachii, nutrient, muscular, upper, and lower ulnar collateral arteries in front of the arm. Its terminal branches; radial, and ulnar arteries arise in the cubital fossa at the level of neck of radius. The lateral terminal branch (LTB); the radial artery (RA) passes deep to the brachioradialis and continues in the lateral side of front of the fore-arm. The medial terminal branch; the ulnar artery passes deep to the pronator teres to continue on the medial aspect of front of the forearm. [1] In the present case, we are reporting an unusual presence of an arterial loop (ansa arterialis) in the cubital fossa formed by the LTB of BrA and an aberrant superficial branch given by the BrA in the middle of the arm.


  Case Report Top


During routine dissection of upper limb for undergraduate teaching in the Department of Anatomy, Melaka Manipal Medical College, Manipal University, India, an unusual arterial loop and aberrant origin of RA was observed in about 60-year-old male cadaver. In the right upper limb of the cadaver, the BrA gave an aberrant branch (AdBrA) on its medial side in the middle of the arm which ran superficially along the basilic vein (BV) in the lower part of the arm and as it reached the roof of the cubital fossa it ran downwards and laterally along with the median cubital vein (MCV) superficial to the bicipital aponeurosis (BA). During its course in the roof of the cubital fossa, this artery crossed the tendon of biceps brachii from medial to the lateral side and joined the LTB of BrA forming an arterial loop in front of the tendon of biceps. A larger branch, which continued as RA and a smaller muscular artery, was taking origin from the summit of this unusual arterial loop. Further course and distribution of the RA was normal. Origin, course and distribution of the ulnar artery were also normal [Figure 1],[Figure 2] and [Figure 3].
Figure 1: Dissected front of the arm and cubital region showing the aberrant branch (AdBrA) arising from the brachial artery (BrA) then passing downwards towards the cubital fossa along the basilic vein (BV) and the median cubital vein (MCV) superfi cial to the bicipital aponeurosis (BA). (MN: Median nerve, BB: Biceps brachii, CV: Cephalic vein)

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Figure 2: Superficial dissection of the cubital region showing the course of the aberrant branch (AdBrA) along the basilic vein (BV) and median cubital vein (MCV) superfi cial to the bicipital aponeurosis (BA). Origin of the radial artery (RA) and formation of the arterial loop (Art loop) is also seen (BB: Biceps brachii, CV: Cephalic vein)

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Figure 3: Deep dissection of the cubital region showing the union of the aberrant branch (AdBrA) and the lateral terminal branch (LTB) of the brachial artery (BrA) to form the arterial loop (Art loop). Origin of the radial artery (RA) and a muscular branch (MB) is also seen (Br: Brachialis muscle, Br R: Brachiaoradialis muscle, BB-T: Tendon of biceps brachii, MTB: Medial terminal branch of the brachial artery)

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  Discussion Top


The Br A has many variations in its course and divisions. The prevalence of the arterial variations in the upper-limb is reported to be from 11% to 24.4%. Of these, the most commonly encountered variation in the arm is a high origin of the radial artery. In a study of 1,200 upper limbs, 2 cases of high origin of RA have been reported and in both cases, it continued as RA in the fore arm. [2] A case of origin of RA as high as from the 2 nd part of axillary artery has also been reported. [3] The frequency of high origin of RA ranges from 3.67% to 14.27% of cases in studies conducted by different workers. [4],[5] In the present case, though there was a high origin of an aberrant artery, it did not continue as the RA. Instead, it joined the normal RA forming an arterial loop in the cubital fossa from which the muscular artery arose. When compared to previously reported varieties abnormalities regarding the arteries of arm and forearm, the observations in the present case are unique.

Clinical importance

Abnormal anatomy of the vessel exposes it to potential danger especially in emergency surgeries and procedures as some of these abnormalities remain symptomless. [6] The brachial and radial arteries are used in interventional cardiology, where they are important access sites for transcatheter diagnostic and therapeutic procedures. [7] The transradial approach for percutaneous coronary procedures has the advantage of reduced access site complications. It may however, be associated with specific technical challenges including transradial procedure failures which can sometimes be due to anatomic variations of radial, brachial, axillary and subclavian artery axis. [8] These procedural failures were observed in patients with the high radial bifurcation (4.6%), radial loop (37.1%), severe radial tortuosity (23.3%) and other anomalies (12.9%). [9] In addition, the course of the AdBrA of the BrA in the roof of the cubital fossa in proximity to the basilic and MCV could expose the vessel to potential danger during routine insertion of the commonly used intravenous canula.

Knowledge of probable variations of brachial and radial arteries is also essential for reconstructive surgeons as some of these variations may significantly affect the harvest, jeopardising the survival of the flap as well as causing ischemia in that region. [5],[10]

The variations reported in the present case such as AdBr A arising from the middle third of the Br A, abnormal course of the AdBr A in the cubital fossa and its relations to the BA would also be important in orthopedic procedures requiring surgery on the bicipital tendon, distal humerus and radial head in trauma and correction of deformities.

 
  References Top

1.Standring S, Borley NR, Collins P, Crossman AR, Gatzoulis MA, Healy JC, et al. Gray's Anatomy: The Anatomical Basis of Clinical Practice. 40 th ed. London: Elsevier, Churchill Liwingstone; 2008. p. 827-35.  Back to cited text no. 1
    
2.Zhan D, Zhao Y, Sun J, Ling EA, Yip GW. High origin of radial arteries: A report of two rare cases. Scientific World Journal 2010;10:1999-2002.  Back to cited text no. 2
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3.Waghmare JE, Tarnekar AM, Sonatakke BR, Bokariya P, Ingole IV. A high origin of radial artery with asymmetrical vasculature of upper limbs: A case report. Nepal Med Coll J 2009;11:284-6.  Back to cited text no. 3
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4.Claassen H, Schmitt O, Werner D, Schareck W, Kröger JC, Wree A. Superficial arm arteries revisited: Brother and sister with absent radial pulse. Ann Anat 2010;192:151-5.  Back to cited text no. 4
    
5.Pelin C, Zagyapan R, Mas N, Karabay G. An unusual course of the radial artery. Folia Morphol (Warsz) 2006;65:410-3.  Back to cited text no. 5
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6.Gravereaux EC, Nguyen LL, Cunningham LD. Congenital Vascular Anomalies. Curr Treat Options Cardiovasc Med 2004;6:129-138.  Back to cited text no. 6
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7.Yokoyama N, Takeshita S, Ochiai M, Koyama Y, Hoshino S, Isshiki T, et al. Anatomic variations of the radial artery in patients undergoing transradial coronary intervention. Catheter Cardiovasc Interv 2000;49:357-62.  Back to cited text no. 7
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8.Chandarana A, Baxi H. Anatomical considerations in transradial intervention. Indian Heart J 2010;62:211-3.  Back to cited text no. 8
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9.Lo TS, Nolan J, Fountzopoulos E, Behan M, Butler R, Hetherington SL, et al. Radial artery anomaly and its influence on transradial coronary procedural outcome. Heart 2009;95:410-5.  Back to cited text no. 9
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10.Acarturk TO, Tuncer U, Aydogan LB, Dalay AC. Median artery arising from the radial artery: Its significance during harvest of a radial forearm free flap. J Plast Reconstr Aesthet Surg 2008;61:e5-8.  Back to cited text no. 10
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    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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