Novel findings of the anatomy and variations of the axillary vein and its tributaries

Abstract

The anatomy and variations of the axillary vein has significant implications in various invasive procedures such as venous access, axillary block, arteriovenous fistula creation, axillary node dissection, breast augmentation, and other surgical procedures involving the axilla. To clarify the anatomy of the axillary vein and its tributaries, 40 cadaveric upper extremities were examined after dissection and were classified into several types according to the courses and terminations of brachial veins. The brachial veins ended separately (Type A; 72.5%) or made a common brachial vein (Type B; 27.5%) to enter the basilic vein or the axillary vein. The basilic vein was absent in 5.0% of the specimens. Duplication of the axillary vein was observed in 17.5% of the specimens and the lateral venous channel running along the lateral wall of the axilla was observed in 40.0% of the specimens. The most common drainage vein of the deep brachial vein was the lateral brachial vein (67.5%). The anterior circumflex humeral vein also emptied into the lateral brachial vein in 67.5% of the specimens. The posterior circumflex humeral vein crossed posterior side of the brachial plexus to join either the axillary vein (45.0%) or subscapular vein (42.5%). Perforation of the lateral root of median nerve by a lateral brachial vein, a common brachial vein, or a venous channel was observed in 15.0% of the specimens. Other venous variations accompanying the variations of the axillary artery or the brachial artery are described herein. The clinical importance of these findings is described in the discussion.

A cephalic vein drained into one of the double axillary veins through the pectoralis major muscle

“…Duplicated variation of the axillary vein was frequently observed in surgical (10%) [8] and anatomic (17.5%) [19] studies.…”

Angiography of Hemodialysis Fistulas and Grafts

“…According to the classical description, the brachial in the basilic veins joined together to form a single axillary vein; however, a double axillary vein is seen in 17.5% of cases (Figure ).…”

“…The most variable venous anatomy in the upper extremity is that of the brachial vein and the basilic vein forming the axillary vein. In an anatomic study of 40 cadaveric upper extremities, the basilic vein was absent in 5% of the specimens and duplication of the axillary vein was observed in 17.5% . In another study of these anatomical variations , the traditional anatomical description in which the basilic vein joins with the two brachial veins to form the axillary vein was present in only two‐thirds the cases (Figure ).…”

Right heart catheterization and other venous cardiovascular procedures from the arm

“…The brachial veins run deeper than the superficial basilic vein, but with the advent of ultrasound techniques to obtain access, may become more common sites of entry into the venous system. Like all the upper arm vasculature, variations exist in the deep brachial system [11], although the significance for central venous access is unknown.…”