Upper limb arterial pattern: clinical correlation and embryological perspective

Abstract

Background Variations in the upper limb arterial pattern are commonplace and necessitate complete familiarity for successful surgical and interventional procedures. Variance in the vascular tree may involve any part of the axis artery of the upper limb, including the axillary artery and brachial artery or its branches, in the form of radial and ulnar arteries, which eventually supply the hand via anastomosing arches. Objectives To study the peculiarities of the arterial pattern of the upper limb and to correlate them with embryological development. Methods The entire arterial branching of forty-two upper limbs of formalin fixed adult human cadavers was examined during routine dissection for educational purposes, conducted over a 3-year period in the Department of Anatomy, Lady Hardinge Medical College, New Delhi. Results The study found: 1) One case in which a common trunk arose from the third part of the axillary artery, which immediately splayed into four branches (2.4%); 2) High division of the brachial artery into ulnar and radial arteries, in 3 cases (7.1%); 3) Pentafurcation of the brachial artery into ulnar, interosseus, radial, and radial recurrent arteries and a muscular twig to the brachioradialis in 1/42 cases (2.4%); 4) Incomplete Superficial Palmar arch in 3/42 cases (7.1%); and 5) Presence of a median artery in 2/42 case(4.8%) Conclusions This study observed and described the varied arterial patterns of the upper limb and identified the various anomalous patterns, supplementing the surgeon’s armamentarium in various surgical procedures, thereby helping to prevent complications or failures of reconstructive surgeries, bypass angiography, and many similar procedures.

A Cadaveric Study on the High Origin of the Radial Artery

“…Anomalous arterial branching pattern results from the numerous alternatives existing during its formation [28] During development, the principal arteries, anastomose, and periarticular networks of capillaries emerge according to a temporal sequence; some initially functionally dominant paths regress subsequently. Differences in the mode and proximodistal branching level, aberrant vessels anastomosing with principal vessels, and vessels forming unexpected neural, myological, or osteo-ligamentous relationships lead to anomalous patterns [1,29]. Arrest at any stage of vessel development followed by regression, retention, or reappearance can lead to variation in arterial origin and branching patterns of major upper limb vessels [23,25].…”