Published online September 30th, 2010 © http://www.ijav.org
Case Report
International Journal of Anatomical Variations (2010) 3: 158–159
Introduction
Brachial artery is the main artery of the arm. It is a continuation of axillary artery at the lower border of teres major muscle. It usually terminates at the level of neck of radius in the cubital fossa by dividing into radial and ulnar arteries. The radial artery runs along the lateral part of the front of the forearm with the superficial branch of radial nerve. The ulnar artery passes medially deep to the pronator teres muscle and then runs to the distal part of the forearm together with the ulnar nerve. Though the branches of radial and unlar arteries take part in the anastomosis around the elbow joint, direct anastomosis between radial and ulnar artery is a rare occurrence. We saw such a direct anastomosis between radial and ulnar arteries in the cubital fossa, which we name as median cubital arch. The radial artery also had a high origin. Case Report
During regular dissections for undergraduate medical students at Melaka Manipal Medical College (Manipal Campus) we encountered arterial variations in a formalin embalmed male cadaver aged approximately 65 years. The variations found were in the right upper limb and were unilateral. The brachial artery was very short. It terminated by dividing into radial and ulnar arteries just below the lower border of teres major muscle (Figure 1). At the origin, the radial artery was medial to the ulnar artery. It first passed medially deep to the median nerve and then crossed it on its superficial aspect from medial to lateral. In the lower part of the arm the Surekha D SHETTY [1]
Raghu JETTI [1]
Cilwyn S BRAGANZA [2]
Satheesha NAYAK B. [1]
SN SOMAYAJI [1]
Department of Anatomy, Melaka Manipal Medical College (Manipal Campus). International Centre for Health Sciences [1] and Department of Anatomy, KMC International Centre [2], Madhav Nagar, Manipal, Karnataka State, INDIA.
Satheesha Nayak B., MSc, PhD Professor of Anatomy
Melaka Manipal Medical College (Manipal Campus) International Centre for Health Sciences Madhav Nagar, Manipal
Udupi District, Karnataka State, 576 104, INDIA. +91 820 2922519
nayaksathish@yahoo.com
Received January 21st, 2010; accepted September 17th, 2010
ABSTRACT
Occurrence of a median cubital arterial arch is very rare. We saw a superficially placed median cubital arterial arch associated with high level of origin of radial artery. The radial artery took origin from the brachial artery in the upper third of the arm and crossed median nerve and ulnar artery from medial to lateral side. The course and distribution of the vessels in the forearm was normal. In the cubital fossa, the radial and ulnar arteries were connected to each other by an arterial arch. The variations reported here are very useful for the radiologists as these variations can cause problems in invasive procedures. © IJAV. 2010; 3: 158–159.
Key words [median cubital arterial arch] [radial artery] [ulnar artery] [brachial artery] [variation]
eISSN 1308-4038
Presence of a median cubital arterial arch associated with high origin of radial artery
radial artery also crossed the ulnar artery from medial to lateral side (Figure 2). At the cubital fossa, the radial and ulnar arteries were connected to one another by a median cubital arterial arch (Figures 2, 3). This arch was deep to the bicipital aponeurosis and gave branches to the superficial forearm muscles. The course, relations and branches of radial and ulnar arteries in the forearm were as usual.
Discussion
The brachial artery usually terminates in the cubital fossa. However, the variations in the termination of the brachial artery are common. A high level of its trifurcation has been noted [1]. Origin of radial artery directly from axillary artery has been reported by Okoro and Jiburum [2]. Bifurcation of brachial artery into superficial brachial artery and deep brachial artery high in the arm has been reported [3]. The superficial brachial artery in this case divided into radial and ulnar arteries in the cubital fossa. Vollala et al. have reported the low level of termination of brachial artery. In their observation, the brachial artery trifurcated into radial, ulnar and common interosseous arteries at the apex of the cubital fossa [4].
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Median cubital arterial arch with high origin radial artery
Figure 1. Dissection of the right upper limb showing the high origin of the radial artery. (BA: brachial artery; RA: radial artery; UA: ulnar artery; MN: median nerve; BB: biceps brachii)
References
[1] Malcic-Gurbuz J, Gurunluoglu R, Ozdogmuş O, Yalin A. Unique case of trifurcation of the brachial artery:
its clinical significance. Clin Anat. 2002; 15: 224–227.
[2] Okoro IO, Jiburum BC. Rare high origin of the radial artery: A bilateral symmetrical case. Nig J Surg Res. 2003; 5: 70–72.
[3] Yoshinaga K, Tanii I, Kodama K. Superficial brachial artery crossing over the ulnar and median nerves from posterior to anterior: embryological significance. Anat Sci Int. 2003; 78: 177–180. [4] Vollala VR, Nagabhooshana S, Bhat SM. Trifurcation of brachial artery with variant course of radial
artery: rare observation. Anat Sci Int. 2008; 83: 307–309. clinically significant as there was a large communication
between radial and ulnar arteries in the cubital fossa. We call this communication as median cubital artery as it was separated by median cubital vein only by the bicipital aponeurosis. This abnormal median cubital artery might cause problems in passing catheters and has not been reported hitherto.
BA
Figure 2. Dissection of the right cubital region showing the radial and ulnar arteries and the median cubital arch. (MCA: median cubital arch; RA: radial artery; UA: ulnar artery; MN: median nerve; PT: pronator teres; BB: biceps brachii; BR: brachioradialis)
Figure 3. Closer view of the right cubital region showing the radial and ulnar arteries and the median cubital arch. (MCA: median cubital arch; RA: radial artery; UA: ulnar artery; MN: median nerve; PT: pronator teres; BT: biceps tendon; BR: brachioradialis)
In the current case, the radial artery crossed the median nerve twice; first from lateral to medial deep to the median nerve and then medial to lateral superficial to the nerve. It also crossed the ulnar artery from medial to lateral side. This course of the radial artery may be clinically significant as it might compress the median nerve or ulnar artery or it might get compressed deep to the median nerve. The presence of the median cubital arch may be advantageous for the blood supply of muscles and for collateral circulation. At the same time, it may bleed severely in superficial injuries. So knowledge of occurrence of such unusual arterial arch may be useful for plastic and orthopedic surgeons.
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