ANOMALOUS ORIGIN OF ANTERIOR INTEROSSEOUS ARTERY

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Int J Anat Res 2015, 3(1):906-09. ISSN 2321-4287 906

Case Report

ANOM ALOUS ORIGIN OF ANTERIOR INTEROSSEOUS ARTERY

Banani Kundu *

1

_{, Abhijit Bisw as}

2

_{, Phalguni Srimani}

3

_{, Alpana De}

4

_.

ABSTRACT

Address for Correspondence: Dr. Banani Kundu, R G Kar M edical College, 1, Khudiram Bose Sarani, Kolkata 700 004, India. M obile: +91 9433366549 E-M ail: dr.bmit ra@yahoo.com

* 1 _{Assistant Professor of Anat omy, R G Kar M edical College, Kolkata, India.} 2,3_{Post Graduate Trainee of Anat omy, R G Kar M edical College, Kolkata, India.}

4_{Professor and Head of t he Depart ment of Anat omy, R G Kar M edical College, Kolkata, India.}

Background: The Br achial Ar t ery ,usually a cont inuat ion of t he axillar y ar t ery begins at t he dist al bor der of t eres m ajor and ends about a cent im et re dist al t o t he elbow joint by dividing int o t he radial and ulnar artery.

Objectives:A. To docum ent t he origin of ant erior int erosseous ar t ery from brachial ar t ery. B. To establish em bryological and clinico-anat om ical correlat ion of such var iat ions.

M et hods:These f indings w ere observed aft er m et iculous dissect ion of t he upper lim bs of bot h sides of a 43 year old adult m ale cadaver in t he depart m ent of anat om y ,R .G .Kar M edical College ,Kolkat a.

Results: The brachial art ery present in t he right lim b gave a branch in t he upper 1/3 of t he arm f rom it s lat eral aspect . This br anch of brachial art ery w ent dow nw ards and becam e deep t o pr onat or t eres and cont inued as t he ant erior int erosseous ar t ery. The brachial art ery it self descended and rem ained superficial t o pronat or t eres. Just below t he elbow joint it underw ent bifurcat ion int o r adial and ulnar art ery.The subsequent course of t hose t w o art eries w as nor m al. And t here w as absence of com m on int erosseous art ery. So t he ant er ior int erosseous art er y inst ead of arising from t he com m on int erosseous art ery w hich w as t he branch of t he ulnar art er y t ook origin from brachial art ery.

Conclusion: This variat ion w as explained in t he light of em bryological developm ent and such variat ions w er e useful for physicians, surgeons, nephrologist s ,radiologist s and int ervent ionist in various surgical procedur es and also for diagnost ic and t herapeut ic approaches.

KEY W ORDS:Brachial ar t ery, Radial art er y, Ulnar art ery, Ant er ior Int erosseous art ery.

BACKGROUND

Int ernat ional Journal of Anatomy and Research, Int J Anat Res 2015, Vol 3(1):906-09. ISSN 2321- 4287 DOI: ht t p:/ / dx.doi.org/10.16965/ ijar.2015.108

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Received: 28 Jan 2015 Accept ed: 16 Feb 2015 Peer Review : 28 Jan 2015 Published (O):31 M ar 2015 Revised: None Published (P):31 M ar 2015

Int ernat ional Journal of Anat omy and Research ISSN 2321-4287

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DOI: 10.16965/ ijar.2015.108

Brachial art ery is a cont inuat ion of t he axillary artery. It begins at t he distal border of t he t eres major muscle and ends by dividing int o t w o branches, lat eral one is t he radial art ery and medial one is t he ulnar art ery [1]. The division takes place at t he level of neck of radius (one cent imet re dist al of t he elbow joint ).

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Banani Kundu, Abhijit Bisw as, Phalguni Sr im ani, Alpana De. ANOM ALOUS ORIGIN OF ANTERIOR INTEROSSEOUS ARTERY.

r ad i al (15%), u l n ar (2%) an d co m m o n interosseous artery. This high division may occur at any point in t he normal course of t he vessel, but it is more common in t he middle t hird. The t w o vessels run parallel t o each ot her t o t he bend of t he elbow, in t he usual posit ion of t he brachial artery. From t his point , one branch follow s t he normal course of t he radial art ery t hrough t he forearm and t he ot her one takes t he normal course of t he ulnar artery. This arrangement is considered a simple high division of t he brachial artery.

Occasio nal ly r ad ial ar t er y ar i ses m or e proximally leaving a common t runk for ulnar and common int erosseous art ery [1]. Proximal division of brachial art ery is due t o failure of disappearance of t he proximal origin of radial art ery and t he radial art ery does not establish new connection w it h t he main t runk near t he origin of t he ulnar art ery [3].

High up division of t he brachial art ery can also b e expl ai n ed by Ar ey w h er e h e comment ed t hat , t here may be persist ence of vessels w hich normally oblit erat e and disappearance or failure of development of vessels which normally persist [4].This reversal o f t h e n or m al p r o cess of vascul ar development is largely due t o alt ered local hemodynamic environment [5].

Fi nal l y, k no w l ed ge o f var i at io n o f t h e br anching pat t er n of br achial ar t er y is n o t ew o r t h y especi al l y i n t h e f iel d o f ort hopedic, radiology, vascular and plast ic surgeries [6].

In t he present case report , w e focused on t he anat omical and embryological basis of t his ar t erial var iat ion and discussed it s clinical significance along w it h relevant review of lit erat ure.

CASE REPORT

These findings w ere observed during rout ine dissect ion of t he upper limbs of bot h sides of a 43 year old adult male cadaver in t he depart ment of anat omy, R .G. Kar M edical College, Kolkat a. The brachial art ery present in right limb gave one branch in upper 1/3rd of arm. Then t he main art ery descended and

RESULTS AND DISCUSSION

remained superficial t o pronat or t eres. Just below t he elbow joint it underw ent bifurca-t ion inbifurca-t o radial arbifurca-t ery labifurca-t erally and ulnar ar-tery medially. Subsequent course of t hose t w o art eries w as normal. The ot her branch of bra-chial art ery w ent dow nw ards and became deep t o pronat or t eres and cont inued as t he anterior interosseous artery. So t he anterior int erosseous art ery inst ead of arising from t he ulnar art ery it t ook origin from brachial art ery and t here w as absence of com mon interosseous artery.

Anomalies of t he upper limb art erial t ree are very much common. This is mainly because of t heir mult iple and plexiform sources, t he t emporal succession of emergence of principal ar t er i es, an ast o m o ses an d p er i ar t icu lar net w orks and funct ional dominance follow ed by regression of som e pat hs [7]. Several variat ions w it h regard t o t he origin and t erminat ion of t he brachial art ery have been reported by many earlier research w orkers.

High origin of radial and ulnar art ery forms t he highest percent age of variat ions of brachial artery. High origin of radial artery occurrence is 3 t o 15%, as report ed by different aut hors. The parent t runk being axillary art ery in 12.5%, proxim al 1/3 of brachial artery in 62.5% and middle 1/3 of brachial art ery in 25% [8].

Occasionally t he br achial ar t er y divides proximally int o tw o trunks, which may reunite. Frequent ly it undergoes high up division more t han usual, and t his short brachial art ery may bifurcat e as usual or it may t rifurcat e int o radial, ulnar and common int erosseous art eries. M ore oft en t he radial branches arise proximally, leaving a common t runk for t he ulnar and common int erosseous; somet imes t he ulnar artery arise proximally, t he radial and common int erosseous art eries forming t he ot her division; t he common int erosseous art ery may also arise proximally[7].

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Fig. 1: Show ing or igin of ant er ior int erosseous art ery from brachial art ery.

Fig. 2: Or i gi n o f t h e Rad i al ,Ul n ar & An t er io r Int erosseous art eries From Brachial art ery.

nerve and absent musculocut aneous nerve [9].

Embryological Explanat ion: Every variat ions in t he peripheral vascular anat om y can be relat ed t o genesis, regression or persist ence of one or ot her segment of t he embryologic axial art ery [10].

Arey and Jurjus report ed six explanat ions for t he variat ions in t he blood vessels of upper limb [4,11]. These are t he choice of unusual pat hs in t he primit ive vascular plexus, t he persist ence of vessels w hich are usually oblit erat ed, t he disappearance of vessels w hich are normally ret ained, an incomplet e development , t he fusion and absorpt ion of part s w hich are norm ally dist inct and a combinat ion of fact ors leading t o an at ypical pat t ern normally encount ered.

The axis art ery of t he upper limb bud is derived from t he lateral branch of t he sevent h intersegmental artery. Proximal part of t he main t runk forms t he axillary and brachial art eries and it s dist al part persist s as t he anterior interosseous artery, close t o t he bend of t he elbow t he axis art ery gives rise t o radial and ulnar art ery w hich are t he lat est art eries t o appear in t he forearm from t he axis artery. Probably in t his case t he axis artery undergoes bifurcat ion. It is im port ant t o m en t i on t h at t he no r m al vascul ar development including t he pat t erning of t he

blood vessels is influenced great ly by t he local hemodynamic fact ors. Alt ered hem o-dynamic environment may give rise t o variant pat t erning of blood vessels [6]. In t his case also due t o difference of flow gradient t he lat eral division of t he axis art ery gradually became narrow er and it formed t he ant erior in t er osseou s ar t er y. The m edi al b ran ch became dominant and it w as cont inued as t he brachial art ery and gave t w o m ore branches t he radial and ulnar artery.

CONCLUSION

Thus any fact ors affect ing during development of t he limb vessels w ill lead t o anomalies in t he level of division of m ajor art er ies. Know ledge regarding such variat ions are very m uch i m p or t ant f o r t h e r adi o l ogi st s, car d i ol o gist s, o r t h o p aed i c and vascul ar surgeon. Diagnost ically t his t ype of variat ion may dist urb t he evaluat ion of angiographic images. Surgeon should be aw are of such variat ion before doing any upper limb surgery t o prevent injury, t hrom bosis specially in pat ient s requiring dialysis or arteriography.

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ACKNOW LEDGEM ENT

The aut hors express t heir heart felt grat it ude t o all t he members of t he Depart ment of Anat omy, R G Kar M edical College, Kolkata f or t heir kind support , cooperat ion and generosit y in t he conduct of t his st udy.

Conflicts of Interests: None

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ANOMALOUS ORIGIN OF ANTERIOR INTEROSSEOUS ARTERY