Palmar arch anatomy: Ajmer Working Group classification

Abstract

Introduction: Forearm arteries are frequently used as workhorse site for cardiac catheterization, bypass grafting and haemodialysis access. There is paucity of data on palmar circulation in live human being and only cadaveric data are available till date. We, therefore, made an attempt to look at the various patterns of sufficient or insufficient palmar arch circulation and various anomalies of forearm arteries, to discuss their clinical implications. Methods and results: We obtained the forearm and hand arteriograms of patients (n ¼ 302) through radial (n ¼ 200) and ulnar routes (n ¼ 102). Modified Allen's test was normal in all of our patients. On the basis of predetermined parameters angiograms were analysed and findings were divided into three groups. These three groups were further classified as type A, type B, type C superficial palmar arch. Conclusion: We concluded that type A superficial palmar arch is most suitable for providing adequate collateral circulation in case of harvesting of forearm vessel, whereas type C superficial palmar arch appears to be highly susceptible for digital ischemia in case of radial or ulnar artery occlusion. Modified Allen's test alone is not justifiable for documenting good collateral circulation and it should be supplemented by other tests to document good collateral circulation before proceeding to any radical procedure.

Variations in the origins and absence of the common digital arteries of the hand: a cadaveric study

“…Unrecognized, these can lead to confusion, difficulty in surgery and may potentially precipitate complications. Variations of the superficial palmar arch and more proximal arteries have been reported (Braun et al., 1977; Gellman et al., 2001; Gokhroo et al., 2016; Ikeda et al., 1988; Joshi et al., 2014; Lippert, 1984; Tasom et al., 2014) . Nevertheless, only a few studies explored anomalies of more distal arteries.…”

Transulnar approach as an alternative to transradial approach in non-coronary intervention: safety, feasibility and technical factors

“…In another patient, TRA was avoided after a patient experienced RAO following a trans-arterial chemoembolization (TACE) procedure via TRA approach performed 56 days earlier. Despite demonstration of a type B reverse Barbeau waveform, TUA was pursued, as Barbeau analysis alone is not justifiable for documenting good collateral circulation, which may have resulted from an accessory artery supplying the ulnopalmar arch (25). In all cases, the ulnar artery was successfully accessed.…”

Anatomical variations of the superficial palmar arch and its clinical relevance

“…In broad terms, two main blood vessels of the hand are the ulnar artery and the radial artery. These two arteries anastomose on the anterior side of the hand and form two arterial archessuperficial and deep palmar arch [2]. The superficial palmar arch undoubtedly occupies a central place in the hand vascular system [3].…”

“…Identification of the most commonly variations of superficial palmar arch is very important for surgical techniques such as use of vascularized skin flaps, synovial flaps, cardiac catheterization and bypass grafting and wrist joint surgery [32,33,34].…”