Int J Anat Res 2015, 3(3):1312-15. ISSN 2321-4287 1312
UNILATERAL VARIATION IN THE BRANCHING PATTERN OF RIGHT
AXILLARY ARTERY
A.K.M anicka Vasuki *
1, M .Nirmala Devi
2, K.Kalyana Sundaram
3, Deborah Joy
Hebzibah
4, T.K.Aleyemma Fenn
5, M .Jamuna
6.
ABSTRACT
* 1 Assistant Professor, Depart ment of Anat omy, PSG Inst it ute of M edical Sciences and Research,
Coimbat ore, India.
2 Associate Professor, Depart ment of Anat omy, PSG Inst it ute of M edical Sciences and Research,
Coimbat ore, India.
3 Associate Professor, Depart ment of Anest hesiology, Coimbat ore M edical College, Coimbat ore,
India.
4 Assistant Professor, Depart ment of Anat omy, PSG Inst it ute of M edical Sciences and Research,
Coimbat ore, India.
5 Former Professor & HOD, Department of Anatomy, PSG Inst itute of M edical Sciences and Research,
Coimbat ore India.
6 Professor & HOD, Depart m ent of Anat omy, PSG Inst it ute of M edical Sciences and Research,
Coimbat ore, India.
Axillary art ery and it s branches are prone t o have variat ions in t heir course. Know ledge about such variat ions are im port ant for Radiologist s in im aging t echniques, Surgeons,Ort hopedicians and Anest het ist s in perform ing sur geries in t he axilla and giving r egional nerve blocks in t he axilla.During dissect ion of a cadaver in t he depart m ent of Anat omy, PSG IM S & R, Coim bat ore, India. We observed a variat ion in t he t hird part of r ight Axi llary art ery. From t he com m on t runk, Subscapular art ery, Ant er ior and Post erior circum flex hum eral art er ies and Prof unda brachii art ery arose. Third part of Axillary ar t ery cont inued dow n as brachial ar t ery. We are highlight ing t he variat ion in t his st udy.
KEY W ORDS:Axi llary Art ery, Com m on Trunk, Art erial Variat ion, Profunda Brachii Art ery, Clinical Significance.
INTRODUCTION
Access this Article online
Quick Response code Web site:
Received: 21 Jul 2015 Accept ed: 19 Aug 2015 Peer Review : 21 Jul 2015 Published (O): 31 Aug 2015 Revised: None Published (P): 30 Sep 2015
Int ernat ional Journal of Anat omy and Research ISSN 2321-4287
ww w.ijmhr.org/ ijar.htm
DOI: 10.16965/ ijar.2015.218
Address for Correspondence: Dr. A.K.M anicka Vasuki, Assistant Professor, Depart ment of Anat omy, PSG Inst it ut e of M edical Sciences and Research, Coimbat ore, India.
E-M ail: [email protected]
Axillary art ery begins as a cont inuat ion of t hird part of Subclavian art ery at t he out er border of t he first rib. It ext ends upt o t he low er border of t he Teres major muscle w here it cont inues as a
brachial artery. It is divided int o t hree part s by Pect oralis minor. It gives off six branches, from t he first part , w hich lies m edial t o Pect oralis m inor, Super ior t horacic ar t er y ar ises; t he second part gives t horacoacromial art ery and Case Report
Int J Anat Res 2015, 3(3):1312-15. ISSN 2321-4287 1313 A.K.M anicka Vasuki et al. UNILATERAL VARIATION IN THE BRANCHING PATTERN OF RIGHT AXILLARY ARTERY: A CASE REPORT.
Lat eral t horacic art eries w hich are deep t o t he above muscle; t he t hird part gives Subscapular, Ant erior and Post er ior cir cum f lex hum er al art eries w hich are lat eral t o t he above muscle. In upt o 30% of t he cases, t he Subscapular art ery can arise from a com m on t runk w it h Posterior circumflex humeral artery. Occasion-ally Subscapular artery, Anterior and Posterior circumflex humeral art eries and Profunda brachii art ery arise as comm on t runk. The Post erior nbcircumflex humeral art ery may arise from a Profunda brachii artery and pass back below t he t eres major t o ent er t he Quadrangular space [1].
CASE REPORT:
During rout ine dissect ion in t he depart ment of Anat omy, PSG IM S & R, Coimbat ore, India, t he axillary region of right upper limb w as exposed in a cadaver. A var iat i on in t he branchi ng pat t ern of t hird part of right Axillary art ery w as observed. From t he first part of Axillary art ery superior t horacic art ery arose as usual and from t h e secon d p ar t of Axi llar y ar t er y, Lat er al thoracic artery and Thoracoacromial art ery arose as usual. From t he t hird part of Axillary artery, Subscapular artery, anterior circumflex humeral artery, Posterior circumflex humeral artery and Profunda brachii art ery arose from a common t runk. In t he left upper limb, t he branches of Axillary art ery w ere found t o be normal.
AA-Axillary Art ery, CT-Com m on Trunk, SA-Subscapular Art ery,
ACHA-Ant erior Circum flex Hum eral Ar t ery, PCHA -Post er ior Circum flex Hum eral Art ery.
Fig. 1: Show ing t he variat ion in t he branching patt ern of t hird par t of right Axillary art ery.
Fig. 2: Show ing t he variat ion in t he branching pat t ern of t hird part of left Axi llary art ery.
ACHA & PCHA
PBA
RN
ACHA-Ant erior Circum flex Hum eral Ar t ery, PCHA-Post erior Circum flex Hum eral Art ery, PBA-Prof unda Brachii Ar t ery, RN-Radial Ner ve.
DISCUSSION
According t o Arey LB 1957 [2], t he unusual blood vessels may be due t o
a. The choice of unusual pat hs in prim it ive vascular plexuses
b. The persist ence of vessels w hich are normally obliterated
c. The disappear ance of vessels w hich ar e normally ret ained
d. Incom plet e developm ent and f usion and absorpt ion of the part s which are usually distinct.
In a st udy Divya agarw al et al. 2013 [3] report ed second par t of Axillar y ar t er y w it h only a Thoracoacromial art ery and t hird part gave t he ant er i or ci r cu m f lex h u m er al ar t er y an d a common t runk which gave Lateral t horacic artery, Subscapular artery, Posterior circumflex humeral artery, Circumflex scapular artery and a muscular branch.
Sat abdi sarkar, Banani kundu et al. 2014 [4] observed from t he second part of Axillary artery, Thoracoacrom ial branch alone and from t he t hird part of Axillary artery, anterior circumflex humeral art ery and a common t runk from which m uscu lar br an ch , Lat eral t h o r aci c ar t er y, Subscapular art ery and Post erior circum flex hum eral artery. Thoracodorsal nerve accomp-anied t he lat er al t horacic ar t ery inst ead of Subscapular artery.
T.Ramesh rao et al. 2008 [5] found t hird part of Axillary artery gave a common t runk, from which CT
AA PCHA
Int J Anat Res 2015, 3(3):1312-15. ISSN 2321-4287 1314 A.K.M anicka Vasuki et al. UNILATERAL VARIATION IN THE BRANCHING PATTERN OF RIGHT AXILLARY ARTERY: A CASE REPORT.
Subscapular artery, anterior circum flex artery, Posterior circumflex humeral artery, Profunda brachii art ery and ulnar collateral artery. This common t runk w as found arising bet w een t he t w o root s of M edian nerve.
Ranjana verma et al. 2014 [6] encount ered t he second part of Axillary art ery Thoracoacromial ar t er y, Subscapular ar t er y and a collat eral branch. From t he collat eral branch, Ant erior and p o st er io r ci r cum f l ex h u m er al ar t er y an d Accesso r y scapu l ar ar t er y ar o se. Th e Subscapular ar t er y f ur t her subdivided int o Circum flex humeral art ery and Thoracodorsal art er y. Third par t of Axi llar y ar t er y had no branches and cont inued dow n as brachial artery.
Kum ar naveen et al. 2014 [7] observed an art erial t runk from t hird part of Axillary art ery w hich cour sed backw ar ds and dow nw ar ds passing bet w een t w o root s of M edian nerve. This anomalous t runk gave all the t hree branches of t hird part of Axillary artery before it continued as Profunda brachii artery.
Ishw ar B.Bagoji et al. 2013 [8] encount ered t he anomalous branching in t he t hird part of Axillary art ery w hich w as t erminat ed int o Subscapular art erial t runk, Superficial and deep brachial art ery. From t he Subscapular art erial t runk, Circumflex scapular artery, Thoarcodorsal artery, Post erior circumflex humeral art ery, Thoraco acrom ial art ery and Lat eral t horacic art eries arose. The deep brachial art ery in t he arm gave anterior circumflex humeral artery at t he surgical neck of humerus w hich t erminat ed in t he cubital fossa by dividing int o radial and ulnar art eries. The superficial brachial artery gave t wo profunda brachii artery, bot h of w hich passed t hrough spiral groove along w it h Radial nerve.
Sat hyanarayana N et al. 2012 [9] observed t hat a common t runk arose from t hird part of Axillary artery w hich gave rise t o Lateral t horacic artery, Ant erior and Post er ior cir cum f lex hum er al art er ies. Subscapular ar t er y t ook it s or igin separately from t hird part of Axillary artery.
Rajesh ast ik et al. 2012 [10] dissect ed eight y upper limbs. They found six different art erial variat ions of Axillary artery. The lateral t horacic art ery arose from Subscapular art ery in nine cadav er s, un i l at er al l y in t w o cases an d b i lat er al l y i n sev en cases. Ab sen ce o f
t horacoacromial art ery t runk w it h origin of all br anches w as dir ect ly f r om Axillar y ar t er y b il at er al ly i n t h r ee cases. A d i v isi o n o f Tho r aco acr o m i al t r u n k gi v es r ai se t o delt oacromial and clavipect oral t runks in t hree cadavers. From t hird part of Axillary artery, a com m on t r unk gave or igin t o Ant erior and Po st er io r ci r cum f l ex h um er al ar t er ies, Subscapular ar t er ies and Pr of unda br achii ar t er ies in f ive cadavers. Double Post erior circum flex hum eral art ery w as found in one cadaver – one from t hird part of Axillary art ery and t he ot her from brachial artery.
This st udy correlates w ith our study. In t his st udy five cadavers show ed common t runk from t hird part of Axillary artery gave Ant erior and Posterior circumflex humeral art eries, Subscapular art ery and Profunda brachii artery.
Variat ions in branching pattern of Axillary artery are due t o defects in embryonic development of t he vascular plexus of upper limb bud.
Embryologically, Axillary artery represent s axial syst em of development t oget her w it h brachial and anterior interroseous artery. In later stages of development , superficial brachial artery from Axillary art ery develops and cont inues as Radial art ery. How ever t he definit ive Radial ar t ery develops as a result of regression of M edian art ery and anast omoses bet w een brachial and superficial brachial art ery w it h regression of proximal segment of superficial brachial artery.
The anom alous branching pat t ern of Axillary art ery w as observed on t he basis of t here may be persistence vessels which normally obliterat e and disappearance or failure of vessels w hich normally persist .
CONCLUSION
Axillary artery and its branches are prone to have variat ions in t heir course. Prior know ledge about t h e var i at io ns i s im po r t an t in p er f o r m in g surgeries in t he axilla and also in giving regional nerve blocks in t he axilla.
Int J Anat Res 2015, 3(3):1312-15. ISSN 2321-4287 1315 t he art ery for microvascular graft t o replace t he
damaged art eries and use t he medial arm skin flap and during the surgical procedure of fracture of upper end of humerus and during M astectomy w it h Axillary dissect ion for carcinoma Breast .
Sound know ledge of Axillary art ery variat ion is im port ant for surgeons, next t o t he poplit eal art ery; t he Axillary art ery is m ore frequent ly lacerated by violence t han any ot her injury. It is found t o be rupt ured in an at t empt t o reduce old di slocat ions, especiall y w hen ar t er y is adh er en t t o ar t i cul ar cap su l e. Hence Rad i o lo gi st s, An est h et i st s, Sur geon s an d Ort hopedicians should know t he Axillary art ery branching pat t ern and it s variat ions.
Conflicts of Interests: None
REFERENCES
[5] . T.Ram esh Rao, Prakashchandra shett y, R. Suresh. Abnorm al branching pat t ern of Axillar y ar t ery and i t s cl i n i cal si gn i f i can ce. I n t . J. M o r p h o l . 2008;26(2):389 – 92.
[ 6] . Ranjana ver m a, Sabit a M ishr a, Anit a M ahajan. Unilat eral variat ion in t he br anching pat t ern of Axi llar y ar t ery: A cadaveric st udy. Int .J.Anat .Res 2014;2(1): 292-94.
[ 7] . Ku m ar N av e en , Pat i l Jy o t h sn a, Sat h ee sh a B Nayak, Rao KG Mohandas,Ravindra S Sw am y, R Deept hinat h,Surekha D Shett y. Variant origin of an ar t erial t r unk f rom Axillary ar t ery cont inuing as p r o f u n d a b r ach i i ar t er y – A u n i q u e ar t e r i al var iat ion in t he axilla and it s clinical im plicat ions. Et hop J Healt h Sci. Jan 2014;24(1):93-96.
[ 8] . Bago j i I B, Had i m an i GA, Ban n u r BM , Pat i l BG, Bharatha A. A unique branching pattern of the Axillary art ery: A case report . J Clin Diagn Res. 2013 Dec;7(1 2):29 39-4 0. d o i : 10 .786 0/ JCDR/20 13/ 5883.3795. Epub 2013 Dec 15.
[ 9] . Sat yan ar ayan a N , Ar u l m o l i R, Su n i t h a P, Chand r alekh a G, Ravin d r anat h G, Jayasr ee N, Sri lahar i N. Variat ion in t he branching patt ern of r ight Axillar y ar t er y in a M alaysian adult m ale cadaver – a case repor t . IOSR Journal of Pharm acy 2012;2(5):19-22.
[ 10] .Ast ik Rajesh, Ur vi Dave. Var iat ions in branching pat t ern of t he axillary ar t ery: a st udy in 40 hum an cadavers. Jornal Vascular Brasileiro 2012; 11(1):12-17.
[1] . Susan st andring. Pect or al girdle, Shoulder region an d axi l l a i n t h e an at o m i cal b asi s o f cli n i cal pract ice, Gray’s Anat omy.40t h ed.London: Churchill
Livingst one 2008.p.817.
[2]. Arey LB. Developmental Anatomy.6th ed. Philadelphia,
W.B.Saunders. 1957;375-77.
[ 3] . Divya agar w al, Nar endr a si ngh, Bi sw a Bhusan M ohant y, and Prafulla Kum ar Chinara. Var iat ion in t he branching pat t ern of Axillar y art ery – a case report . Int .J.Anat Var.2013;6:31-33.
[4] . Satabdi sar kar, Banani kundu, Pallab Kum ar Saha. Var iat ion of branching patt ern of Axi llary art ery. Int .J.Anat .var.2014:7:27-29.
How to cite this article
:
A.K.M anicka Vasuki, M .Nir m ala Devi, K.Kalyana Sundaram , Deb or ah Jo y Heb zi bah, T.K.Al eyem m a Fen n, M .Jam u na. UNILATERAL VARIATION IN THE BRANCHING PATTERN OF RIGHT AXILLARY ARTERY: A CASE REPORT. Int J Anat Res 2015;3(3):1312-1315. DOI: 10.16965/ ijar.2015.218
