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 Table of Contents  
CASE REPORT
Year : 2013  |  Volume : 27  |  Issue : 1  |  Page : 78-79

Bilateral double brachial artery


1 Department of Anatomy, Regional Institute of Medical Sciences, Imphal, India
2 Department of Orthopaedics, Jawaharlal Nehru Institute of Medical Sciences Hospital, Imphal, India

Date of Web Publication17-Aug-2013

Correspondence Address:
Deven Singh Irungbam
Department of Anatomy, Regional Institute of Medical Sciences, Imphal - 795 004, Manipur
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-4958.116655

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  Abstract 

Arterial anomalies of the upper limb are frequently encountered during cadaveric dissections. An adult female cadaver was found to have double brachial arteries bilaterally. The superficial brachial arteries ended near the elbow by dividing into radial and superficially running ulnar arteries whereas the deep brachial artery continued as common interosseous artery. Persistence of both the primitive arterial systems has been claimed to lead to such anomalies. Knowledge of such anomaly is important to avoid diagnostic and therapeutic misadventures.

Keywords: Double brachial artery, Superficial brachioulnoradial artery, deep brachial artery


How to cite this article:
Irungbam DS, Singh L B, Huidrom RD, Th NS. Bilateral double brachial artery. J Med Soc 2013;27:78-9

How to cite this URL:
Irungbam DS, Singh L B, Huidrom RD, Th NS. Bilateral double brachial artery. J Med Soc [serial online] 2013 [cited 2020 Sep 20];27:78-9. Available from: http://www.jmedsoc.org/text.asp?2013/27/1/78/116655


  Introduction Top


Normally there is a single brachial artery and their branches supply the upper limb. When two brachial arteries are present, one runs a superficial course and is called superficial brachial artery (SBA). The other takes a deep course and is known as deep brachial artery (DBA). They share the branches in different ways and accordingly exhibit various forms of anomalies. We report an interesting bilateral case of double brachial artery.


  Case Report Top


Two brachial arteries were found bilaterally in an old female cadaver during routine dissection in the Department of Anatomy, Regional Institute of Medical Sciences, Imphal. The (SBA), on both sides, arose from the third part of the axillary artery near the lower border of pectoralis minor. On both sides, the subscapular artery arose from the axillary artery proximal to the origin of the SBA but the circumflex arteries arose distal to it. The SBA, on both sides, ran superficial to the medial root of median nerve and to the nerve itself and divided into radial and ulnar-at the level of intercondylar line in the case of the left side and 4 cm above it on the right side. The radial and ulnar arteries coursed superficial to the bicipital aponeurosis on both sides. The radial artery had anormal course. The ulnar artery, after coursing over the pronator teres and flexor carpi radialis, disappeared beneath the lateral border of palmaris longus about 8 and 6 cm below intercondylar line on the right and left sides respectively and came to the usual position. The DBA, arising as the continuation of the axillary artery, on both sides, supplied the usual arm branches but continued into the forearm as common interosseous trunk. The DBA artery gave off ulnar collaterals and on the left side, gave off a small median artery and then bifurcated into anterior and posterior interosseous arteries. On the right side, the common interosseous trunk trifurcated into anterior interosseous, posterior interosseous and median arteries. On both sides, median artery was present and was antebrachial in type. [Figure 1] and [Figure 2]
Figure 1: Double brachial artery on the right side

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Figure 2: Double brachial artery on the right side

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  Discussion Top


When two brachial arteries are present, the superficial of the two may divide at the elbow into radial and ulnar arteries passing over the superficial muscles of the forearm coexisting in the whole arterial pattern of the limb with a normal brachial artery that continues as the common interosseous trunk, it is called superficial brachioulnoradial artery. [1] The superficial brachioulnoradial artery is found in 1.04% of cadavers and 0.52% of upper limbs. [1] Laterality and sex distribution of the condition are not known. The origin of SBA may be from brachial artery or axillary artery. The superficial brachial arteries had high division and though the ulnar artery passed superficial to the superficial flexor forearm muscles, it was deep to palmaris longus. In the present case, the radial recurrent branch came from the radial artery. Rodríguez-Niedenführ et al. [2] suggested the presence of two systems of arteries-one deep which persists as the definitive pattern and another superficial which later regresses, with anastomoses between them. Normally, the superficial system regresses due to the hemodynamic predominance of the deep system. Non-regression of the superficial system and the obliteration of the deep trunks of origins of the radial and ulnar arteries in the primitive axial artery lead to the formation of the superficial brachioulnoradial artery and whether the origin of the SBA is from brachial or axillary arteries will depend on which of its primitive trunks of origin persists. [1] Superficially located arteries are liable to injury and hemorrhage. [3] There can be inadvertent injections into superficially located anomalous arteries which are mistaken for subcutaneous veins. [4] Intrarterial injections of anomalous upper limb arteries can also cause wrong interpretation of angiographic results. [5] The SBA can be used as a basis for medial arm flap for reconstructive operations. [6] The awareness of these anomalies in the upper limb is needed to avoid any unintentional diagnostic and therapeutic misadventures.

 
  References Top

1.Rodríguez-Niedenführ M, Vázquez T, Nearn L, Ferreira B, Parkin I, Sañudo JR. Variations of the arterial pattern in the upper limb revisited: A morphological and statistical study, with a review of the literature. J Anat 2001;199:547-66.  Back to cited text no. 1
    
2.Rodríguez-Niedenführ M, Burton GJ, Deu J, Sañudo JR. Development of the arterial pattern in the upper limb of staged human embryos: Normal development and anatomic variations. J Anat 2001;199:407-17.  Back to cited text no. 2
    
3.Anagnostopoulou S, Venieratos D. An unusual branching pattern of the superficial brachial artery accompanied by an ulnar nerve with two roots. J Anat 1999;195:471-6.  Back to cited text no. 3
    
4.Sen S, Chini EN, Brown MJ. Complications after unintentional intra-arterial injection of drugs: Risks, outcomes, and management strategies. Mayo Clin Proc 2005;80:783-95.  Back to cited text no. 4
    
5.Uglietta JP, Kadir S. Arteriographic study of variant arterial anatomy of the upper extremities. Cardiovasc Intervent Radiol 1989;12:145-8.  Back to cited text no. 5
    
6.Karamürsel S, Baðdatli D, Demir Z, Tüccar E, Celebioðlu S. Use of medial arm skin as a free flap. Plast Reconstr Surg 2005;115:2025-31.  Back to cited text no. 6
    


    Figures

  [Figure 1], [Figure 2]



 

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