Median artery bilateral persistence in coexistence with a bifid median nerve and a communication with the ulnar nerve and vice-versa

Abstract

Purpose The current report describes the bilateral coexistence of a persistent median artery (PMA) of ulnar origin and asymmetrical termination, with a bifid median nerve (MN) and an interconnection of the median with the ulnar nerve (MN-UN). Unilaterally the “reverse” interconnection (MN-UN) was identified. Emphasis was given to the artery’s developmental background. Methods The PMA was identified in an 80-year-old formalin-embalmed male cadaver, derived from a body donation program after a signed informed consent. Results In the right forearm, the PMA of antebrachial type, terminated at the wrist, posterior to the palmar aponeurosis. Two neural communications (-) were identified: the UN-MN deep branch, at the forearm’s upper third, and the MN deep stem-UN palmar cutaneous branch, at the lower third (9.7cm distally to the 1st communication). In the left forearm, the PMA of palmar type, ended in the palm giving off the 3rd and 4th proper palmar digital arteries. An incomplete superficial palmar arch was identified by the PMA, radial and ulnar arteries’ contribution. After MN bifurcation into superficial and deep branches, the deep branches formed a loop, through which coursed the PMA. The MN deep branch communicated with the UN palmar cutaneous branch. Conclusions The PMA should be evaluated, as a causative factor of carpal tunnel syndrome. The modified Allen's test, and the Doppler ultrasound may detect the arterial flow and the angiography may depict the vessel thrombosis in complex cases. PMA could also be a "salvage" vessel for the hand supply, in radial and ulnar artery trauma.

Thrombosed Persistent Median Artery with Coexisting Bifid Median Nerve in a Robotic Arthroplasty Surgeon

“…They terminate either proximal to the wrist or distally in the form of complete or incomplete SPAs 2-4,49-51 . PMAs can rarely coexist with other neurovascular anomalies such as a BMN 6-12 .…”

“…However, it may occasionally persist into adulthood 4,5 . Rarely, PMAs have been found to coexist with a bifid median nerve (BMN) [6][7][8][9][10][11][12] . The presence of a persistent median artery (PMA) has been reported to be associated with the occurrence of compression neuropathy 2,3,5,[13][14][15] -caused directly or secondary to associated pathology of the PMA including calcification, atherosclerosis, and thrombosis [16][17][18][19][20][21][22][23][24] .…”