Variations In Branching Pattern Of Brachial Artery – A Study In Cadavers

Brachial artery in arm is commonly used for percutaneous arterial catheterization, angiography, vascular flaps for reconstructive surgeries, and can be injured in fractures of arm or elbow region. Knowledge of variations in branching pattern is must for all clinicians and especially for vascular and orthopaedic surgeons to avoid complications like haemorrhage, ischemia and necrosis during various surgical procedures. This study was done to observe variations in branching pattern of brachial artery in cadavers and its clinical applications. The study was conducted on eighty upper limbs of 40 cadavers (30 males and 10 females) of age group 50-70 years in the Dept of Anatomy, R.N.T. Medical College, Udaipur (Raj). In 30 cadavers branching pattern of brachial artery was normal. In 10 cadavers either unilaterally or bilaterally variable branching pattern was noticed in the form of (1) Absence of profunda brachial artery (2) Origin of Profunda brachii artery from axillary artery (3) Termination of brachial artery i.e. in the middle of arm into radial and ulnar artery (4) Termination of brachial artery in arm into medial and lateral branches continuing distally as radial and ulnar artery respectively. Genetic predisposition, chemical factors or hemodynamic forces can be the reasons for arterial variations in the upper limb.

Anomalies of Arch of Aorta and Its Branches - Computed Tomography Angiography Study

Introduction: The arch of aorta is a curved structure between the ascending aorta and the descending aorta.Three branches arise from the superior aspect of the arch- Brachiocephalic trunk, Left common carotid artery and Left subclavian artery. The aortic arch and its branches are well known for their anomalies which are important causes of cardio-vascular morbidity and mortality. The present study contribute for awareness and alertness regarding their incidence and prevalence for radiologists, cardiologists and endo-thoracic surgeons and to prevent complications during therapeutic procedures. Subjects and Methods: 500 CTA images were studied retrospectively from the patients who underwent chest and neck CTA for different reasons. Results: Out of 500 patients 474 (94.8%) patients had the classical branching pattern with left sided aorta. Six types of anomalies of the aortic arch and its branches were found in 26 (5.2%) patients. The most common anatomical variant was a common trunk for Brachiocephalic trunk and Left Common Carotid artery (bovine arch) found in 9 (1.8%) patients. In five (1%) patients, Left Vertebral Artery arises directly from the arch of aorta between left common carotid artery and left subclavian artery. Five (1%) patients had Right sided arch of aorta. Aberrant Right subclavian artery was found in four (0.8%) patients. Double arch in 2 (0.4%) cases and in one (0.2%) patient, we observed five branches arising directly from the arch, they are Right Common Carotid artery, Left Common Carotid artery, Left Vertebral artery, Left Subclavian artery and Aberrant Right Subclavian artery. Conclusion: With the ever increasing day to day advancements in complex endovascular interventions for the aorta and other great vessels of head and neck regions, early identification of aortic arch variant anatomy is of clinical significance to the radiologists and endovascular surgeons.

A Study On Course And Variations Of Facial Artery On The Face

Introduction: Face is mainly supplied by the Facial artery supplemented by transverse facial artery. Variations inthe course and branching pattern of facial artery are commonly seen. The understanding of these variations offacial artery plays a very important role in facio-maxillary surgeries. It is also of immense importance toradiologists in interpreting facial artery angiography.Materials and Methods: The present study was conducted in the Department of Anatomy, Subbaiah Institute ofMedical Sciences on 50 formalin fixed adult hemi-faces irrespective of sex. The branching pattern, terminationsand variations of facial artery on the face were studied.The facial artery predominantly terminated as angular artery in 28 (56%) hemi-faces, as superior labial arteryin 15 (30%) hemi-faces and as lateral nasal artery in 6 (12%) hemi-faces.Results: An inconstant posterior (pre-masseteric) branch of facial artery was observed in 3 (6%) hemi-faces. Inone of the hemi-face we found a deviation in the usual course of facial artery, where the artery deviated towardsthe infra-orbital foramen then continued and terminated as the lateral nasal artery. An unusual termination offacial artery was observed in one of the hemi-faces where the artery terminated by giving 4 branches in the lowerbuccal region.Conclusion: Knowledge of these variations and anomalous branching pattern is of great academic and clinicalsignificance in general practice, Otorhinology, Traumatology, Plastic and Maxillofacial surgeries and Radiology

A cadaveric study on variations in branching pattern of external carotid artery / 대한해부학회지

Variations in the vascular anatomy of the carotid triangle have been reported in current scientific literature. The carotid arteries, being the major feeding arteries of the head and neck deserve special importance and protection from iatrogenic injury during radiological evaluations and surgical interventions. The present study was carried out over a period of 4 years from 2012–2016 to assess the variant anatomy of external carotid artery. The external carotid artery and its branches were dissected bilaterally in 40 formalin embalmed cadavers. The external carotid artery was traced from its origin to termination and variations in the branching pattern as well as the level of the carotid bifurcation were observed and analysed. A higher carotid bifurcation was observed in 25% cases. The linguofacial trunk was the commonest variation noted in the branching pattern seen in 20% cases. A single case of unilateral thyrolinguofacial trunk was also observed. The external carotid artery gave rise to accessory branches in 7.5% cases namely the superior laryngeal, accessory ascending pharyngeal and masseteric branches. A slender branch to the internal jugular vein was also observed in one case. These findings may provide further insight into the understanding of the vascular anatomy of the carotid triangle to the curious student, the discerning radiologist and the vigilant surgeon to avert complications and help improve overall treatment outcome.

A rare double profunda femoris artery in a female cadaver / 대한해부학회지

The profunda femoris artery (PFA) represents the first and largest branch of the femoral artery in the thigh. A series of anatomical variations are reported, mostly concerning its point of origin and its altered trajectories within the lower limb. We present a rare case of a double PFA, where each separate branch followed the expected arterial pattern. Our case aim to alert surgeons and radiologists for the possibility to encounter an unexpected vascular alternation. Knowledge of topographical anatomy of the PFA and its variations is essential for possible complications after interventional procedures to be avoided.

Classification and fascicular analysis of variant branching pattern of femoral nerve for microsurgical intervention: a series of thirteen cadavers / Clasificación y análisis fascicular de las variantes en el patrón de ramificación del nervio femoral en intervenciones microquirúrgicas: una serie de 13 cadáveres

Femoral neuropathy associated with lower limb is treated by surgical intervention through activation/regeneration/grafting of nerve fibers by a nerve cuff electrode implant or neuro-prosthesis. These procedures require detailed and precise knowledge of neuro-anatomical variants of the femoral nerve and its fascicular anatomy so that the nerve injury can be investigated and treated more efficiently. The aim of the study is to uncover the variations both in the femoral nerve and its branches, to classify them and to bring out corresponding fascicular anatomy using a hypothesis based on the principle of consistency, continuity and traceability of fascicles. The study was carried out in the Department of Anatomy AIIMS Rishikesh using 13 matched lower limbs (26 femoral nerves) from 13 cadavers. The femoral nerve was exposed in the femoral triangle and traced to the posterior abdominal wall. Variations in the shape, size and course of the femoral nerve and its branches were analyzed. The fascicular arrangement was also conceptualized based on the hypothesis. Seven classes, high division, trunk anomaly, semi-scattered, scattered branching pattern, pectocutaneous, lateral cutaneous nerve of thigh and nerve to sartorius anomalies were detected. The corresponding fascicular organizations were modeled. The seven classes along with corresponding fascicular pattern will be very useful for neurosurgeons, radiologists, anesthetists and anatomists in diagnosis and treatment of femoral neuropathy.

La neuropatía femoral asociada con el miembro inferior es tratada por intervención quirúrgica a través de activación, regeneración e injerto de fibras nerviosas mediante un implante de electrodo de manguito de nervios o neuro-prótesis. Estos procedimientos requieren un conocimiento detallado y preciso de las variantes neuro-anatómicas del nervio femoral y su anatomía fascicular de modo que la lesión del nervio pueda ser investigada y tratada de manera más eficiente. El objetivo del estudio fue descubrir las variaciones tanto en el nervio femoral y sus ramas y clasificarlos a partir de la anatomía fascicular utilizando una hipótesis basada en el principio de la continuidad y trazabilidad de los fascículos correspondientes. El estudio se llevó a cabo en el Departamento de Anatomía AIIMS Rishikesh utilizando 13 miembros inferiores pareados (26 nervios femorales) de 13 cadáveres. El nervio femoral se expuso en el triángulo femoral y fue trazado en la pared abdominal posterior. Se analizaron las variaciones en la forma, tamaño y trayecto del nervio femoral y sus ramas. El patrón fascicular fue conceptulizado de acuerdo a la hipótesis planteada. Se detectaron anomalías clasificadas en: siete clases, división alta, anomalías de tronco, semi-dispersos, patrón de ramificación dispersa, pectocutáneo, nervio cutáneo lateral y nervio del músculo sartorio. Las clasificaciones junto con el patrón fascicular correspondientes serán de gran utilidad para los neurocirujanos, radiólogos, anestesistas y anatomistas en el diagnóstico y tratamiento de la neuropatía femoral.

Variations and Anomalies of Coronary Artery System in Cadaveric Human Hearts.

Background: Knowledge of the normal and variant anatomy and anomalies of coronary circulation is an increasingly vital component in the management of congenital and acquired heart disease. Anatomical variations in relation to coronary artery and its branches will help cardiac surgeons for refining imaging techniques and coronary artery bypass grafting. The current study is aimed at understanding the normal patterns of coronary arteries with reference to its predominance, branching pattern, variations and anomalies. Methods: Heart specimen for this study were obtained from Department of Anatomy, SIMS Hapur and GFIMSR Ballabhgarh. The cadaveric human hearts were dissected to observe the coronary arteries and its branches. Results: The diameter of right and left coronary orifices were measured. The distance of the orifices from the supravalvular ridge was also measured. The length and the diameter of the coronary arteries and its branches were measured and statistical significance was determined. Conclusion: The present study revealed that, ostium diameter of left coronary artery is larger than the right coronary artery. The outer diameter of the left coronary artery is larger than the right coronary artery. The mean lumen circumference of left coronary artery, anterior interventricular artery, right coronary artery and circumflex artery is more in males as compared to female. This knowledge is important for interpretation of the coronary angiography and surgical myocardial revascularization and paramount to cardiac surgeons for proper diagnosis and treatment of cardiac ailments and radiologists to refine image interpretation.

Study of Right Marginal Artery in Adult Human Hearts of Hyderabad Karnataka Region.

Background and objectives: Coronary artery anomalies are known to be associated with congenital heart defects, myocardial ischemia and reduced life expectancy. The sound knowledge of coronary artery anatomy is necessary for proper management of patients undergoing evaluation for percutaneous coronary intervention, coronary artery surgery or prosthetic valve replacement. The present study is done to determine the origin, course and variation of right marginal artery for proper diagnosis and treatment of the heart diseases. Materials and Methods: The present study is done on 76 adult heart specimens obtained from routine dissection conducted for undergraduate students in the Department of Anatomy at Bidar Institute of Medical Sciences, Bidar and also from other nearby medical colleges of Karnataka and Maharashtra. The data obtained is tabulated and analysed statically. Results: In our study it is observed that the right marginal artery is present in 88% cases and is absent in 12% cases. Right marginal artery terminates before inferior border in 19%, in between inferior border and apex in 78%, and in 3% cases right marginal artery terminates at apex. Conclusion: The present study is done to know the normal and variant anatomy of right marginal artery in Hyderabad Karnataka region to provide vital inputs for making a correct diagnosis and planning treatment for procedures like coronary angiography, stenting procedures and surgical myocardial revascularization as the right marginal artery terminating at apex can irrigate the inferior third of heart, diaphragmatic area limiting the possibility of ischemic process in the occlusion of anterior interventricular artery.

Variation in brachial plexus formation, branching pattern and relation with major vessels.

Background: Anatomical variations in the formation, branching pattern and relations of the brachial plexus have been described in humans by many authors; however these have not been extensively catalogued. The aim of the study was to describe variations in brachial plexus formation, branching pattern and relation with major vessels. Methods: This study included thorough dissection of 60 brachial plexuses which belonged to 30 cadavers (male: female ratio = 28:02 ) with age range of 20-60 years, obtained from the Department of Anatomy, College of Medical Sciences (CMS-TH), following standard guidelines. Results: Out of 60 limbs dissected in present study, the variation in formation was found in 20 limbs (33.3%), out of which 12 limbs (20%) had variations in the trunk and 8 limbs (13.3%) had variations in the cord, remaining 40 limbs (66.6%) were normal in the formation of brachial plexus. Normal branching pattern of the posterior cord was encountered in 52 (86.67%) limbs, the remaining 8 (13.33%) being variants in one form or the other. The upper subscapular nerve, the thoracodorsal nerve, the lower subscapular nerve and the axillary nerve were found to arise normally in 91.66%, 96.66%, 96.66% and 98.33% of the limbs respectively. Conclusion: The present study carried out on adult human cadavers revealed some rare variations in the formation, branching pattern and relations of the brachial plexus. These variations are of clinical significance for the surgeons, radiologists and the anesthesiologists.

A Rare Case With Multiple Variations Of Liver And Associated Arteries.

Variations of liver, its arterial supply and branching pattern of coeliac trunk are not uncommon as separate entity but this case presents several variations. During routine dissection, a multi-lobular liver, with irregular inferior margin, was observed occupying only right upper quadrant of the abdomen. An extra (accessory) lobe was hanging from its inferior surface. Common hepatic artery was giving eight branches, six on left side and two on right side. Five of the left branches were entering liver but none was passing through porta hepatis. Coeliac trunk showed tetrafurcation; the additional branch was supplying pancreas and transverse colon. Knowledge of these variations or combinations is important in open access surgeries, endoscopic surgeries and diagnostic and interventional radiology of the region.

Frequency of abnormal branching pattern of axillary artery: a cadaveric study.

Many authors suggest that abnormal branching pattern of axillary artery is very common. This compelled us to explore the axillary region of 20 formalin fixed cadavers of either sex to note the frequency of unusual branching of axillary artery over a period of five years. Axillary artery branched normally as described in various textbooks of Anatomy in thirty nine (97.5%) out of forty axillae examined. Only in one axilla (2.5%), it was observed that the second part of axillary artery branched unusually whereas on the other side it branched normally. Knowledge of such abnormal presentation of the axillary artery in the era of reconstructive surgeries is of great help to the interventionist so as to avoid any vascular catastrophe resulting in some kind of mishap. Awareness of such unusual branching pattern of axillary artery is also of great importance to vascular surgeons and radiologists dealing with this region. Embryological origin and the clinical relevance of the abnormality encountered in the branching pattern of the axillary artery in the present study have been discussed in the paper.

Coeliac Trunk Variations:Review With Proposed New Classification.

Coeliac Trunk (CT), the first ventral branch of the abdominal aorta is the major source of blood supply to the supracolic abdominal compartment. Usually, it branches into the splenic, common hepatic and left gastric arteries to supply this region. Anatomical variations of celiac trunk and its branching pattern frequently found during cadaveric dissection and diagnostic radiological imaging have been reported by numerous authors. Although the variations in coeliac trunk are usually asymptomatic, they may become important in patients undergoing diagnostic angiography for gastrointestinal bleeding or prior to an operative procedure. The knowledge of this results in more accurate treatment. In the past many years, investigators have classified the CT based on its branching pattern. However, these classifications have not been able to encompass all the types of variations that have been reported till date. Therefore, in this article we have tried to include most of the types of variations reported till date and put forward a new classification of CT that incorporates most of the variations reported so far. Besides this an attempt has been made to explain the embryological basis of these variations.

The great auricular nerve in fetuses / El nervio auricular mayor en fetos

The great auricular nerve (GAN) is the largest branch of the superficial cervical plexus that winds around the posterior border of the sternocleidomastoid muscle, accompanied by the external jugular vein. Forty fetuses (right side: 40/80; left: 40/80) with gestational ages between 15 to 28 weeks were microdissected to document the anatomy of the GAN. The results obtained were classified as: i) Incidence and morphometry: GAN was present in 100 percent of the fetal specimens with average length on the right and left sides recorded as 12.65 +/- 2.14 mm and 12.55 +/- 2.82 mm respectively. ii) Course: GAN was located parallel to the transverse cervical nerve and the external jugular vein. Duplicate external jugular veins were observed in 5 percent (4/80) with GAN located anterior to one of the tributaries; iii) Branching Pattern: 16 percent (13/80) of specimens depicted a single branch. Duplicate branches in 67 percent (54/80) (referred to as Type I: anterior and posterior branches and 33 percent (26/80) referred to as Type II: anterior and posterior branches; iv) Variation: the transverse cervical nerve formed a communication with GAN, inferior to the parotid gland in 1 percent. The anatomical knowledge of the course, bifurcation pattern and variations of GAN may prevent complications during surgical procedures such as parotidectomies.

El nervio auricular mayor (NAM) es el ramo más grande del plexo cervical superficial que gira alrededor del margen posterior del músculo esternocleidomastoideo, acompañado de la vena yugular externa. Cuarenta fetos (lado derecho: 40/80; izquierdo: 40/80), con edades gestacionales de 15 a 28 semanas fueron microdisecados para describir la anatomía del NAM. Los resultados obtenidos se clasificaron en: i) Incidencia y morfometría: NAM estaba presente en el 100 por ciento de las muestras fetales con una longitud media de los lados derecho e izquierdo de 12,65+/-2,14mm y 12,55+/-2,82mm, respectivamente. ii) Curso: NAM se encuentra paralelo al nervio cervical transverso y la vena yugular externa. Duplicación de las venas yugulares externas se observaron en el 5 por ciento (4/80) con el NAM situado por delante de uno de los afluentes, iii) Patrón de ramificación: 16 por ciento (13/80) de las muestras presentaba una solo ramo. Ramos duplicados en el 67 por ciento (54/80) de Tipo I, ramos anterior y posterior y, el 33 por ciento (26/80) Tipo II, ramos anterior y posterior, y iv) Variación: el nervio cervical transverso formando una comunicación con NAM, inferior a la glándula parótida en el 1 por ciento. El conocimiento anatómico del curso, patrón de bifurcación y variaciones del NAM pueden prevenir las complicaciones durante los procedimientos quirúrgicos como la parotidectomía.

Variations in the branching pattern of the aortic arch in three Trinidadians / Variaciones en los Patrones de Ramificación Del arco Aórtico en Tres Tinitenses

In routine anatomical dissections for the purpose of preparation of teaching and museum specimens, it was observed that three cadavers of elderly Trinidadian males (of African descent) showed uncommon origin and variations in the number of branches of the aortic arch.

En disecciones de rutina con el propósito de preparar la enseñanza así como especímenes de museo, se observó que tres cadáveres de hombres mayores trinitenses (de descendencia africana) mostraban un origen poco común y variaciones en el número de ramas del arco aórtico.

Branching Pattern of the Facial Nerve in the Parotid Gland

Iatrogenic injury of the facial nerve branch is the main complication during a parotidectomy, leading to functional damage in the patient. An exact and thorough understanding of the anatomy of the branching pattern of the facial nerve in the parotid gland is prerequisite for surgeons performing a parotidectomy. The aim of this study was to elucidate the branching pattern of the facial nerve inside the parotid gland. The relationships between the branches of the facial nerve were investigated in 23 adult faces during parotidectomies for various etiologies. The branches of the facial nerve were divided into six types according to their branching patterns and their communication. Straight branching with two subtrunks was seen in 12 (52%) out of the 23 cases (Type I), two buccal branches from the lower and upper subtrunks was seen in 4 (17%) cases (Type II), and anastomosis between the buccal and zygomatic branches in 4 (17%) cases (Type III). There were multiple anastomoses among the temporal, zygomatic and buccal branches in 2 (9%) cases (Type IV). Only one (4%) case had buccal branch stemming from the marginal mandibular branch (Type VI). In most cases, the buccal branch was the thinnest. We think that many of the patients having a parotid tumor would possibly show a Type I branching pattern during a parotidectomy. Although the marginal mandibular branch was known to have a long course, almost no anastomosis with other branches, and the most devastating functional damage after iatrogenic injury. Surgeons should be especially careful during the dissection along the course of buccal branch, which may be the thinnest, and prone to damage, transiently or permanently, following the procedure.

The branching pattern of major groups of land plants inferred from parsimony analysis of ribosomal RNA sequences.

The parsimony and bootstrap branching pattern of major groups of land plants derived from relevant 5S rRNA sequence trees have been discussed in the light of paleobotanical and morphological evidences. Although 5S rRNA sequence information is not useful for dileneating angiosperm relationships, it does capture the earlier phase of land plant evolution. The consensus branching pattern indicates an ancient split of bryophytes and vascular plants from the charophycean algal stem. Among the bryophytes, Marchantia and Lophocolea appear to be phylogenetically close and together with Plagiomnium form a monophyletic group. Lycopodium and Psilotum arose early in vascular land plant evolution, independent of fem-sphenopsid branch. Gymnosperms are polyphyletic; conifers, Gnetales and cycads emerge in that order with ginkgo joining Cycas. Among the conifers, Metasequoia, Juniperus and Taxus emerge as a branch independent of Pinus which joins Gnetales. The phylogeny derived from the available ss-RNA sequences shows that angiosperms are monophyletic with monocots and dicots diverging from a common stem. The nucleotide replacements during angiosperm descent from the gymnosperm ancestor which presumably arose around 370 my ago indicates that monocots and dicots diverged around 180 my ago, which is compatible with the reported divergence estimate of around 200 my ago deduced from chloroplast DNA sequences.