Common arterial trunk for the branches of the third portion of the axillary artery: description of a case and its clinical application / Tronco arterial común para las ramas de la tercera porción de la arteria axilar: descripción de un caso y su aplicación clínica

SUMMARY: Variations of the axillary artery may have clinical implications capable of generating unexpected situations during surgical procedures of arterial reconstruction or vascular catheterization. The objective of this work was to report the finding of an anatomical variant of the axillary artery, which may have clinical and surgical implications. A descriptive study was conducted, in which a unilateral vascular variation found during a routine dissection in a right upper limb of a male cadaver was reported. From the second portion of the axillary artery originated a common arterial trunk that gave rise to the subscapular, anterior humeral circumflex, posterior humeral circumflex and deep brachial arteries. The third portion of the axillary artery did not emit branches. The common arterial trunk originated from the second portion, 62.64 mm from the beginning of the axillary artery. Its total length was 23.72 mm and its thickness was 6.1 mm. The caliber of the branches originating from the common arterial trunk was: subscapular artery 5.1 mm, anterior humeral circumflex of 1.66 mm, posterior humeral circumflex 3.18 mm and deep brachial 3.73 mm. The vascular variant detected altered the anatomical relationship of the axillary artery with the brachial plexus, generating a modification in the position of the fascicles and their terminal branches. Anatomical variations of the axillary artery are not infrequent, knowing them may be necessary during surgical procedures or anatomical dissections.

RESUMEN: Las variaciones de la arteria axilar pueden tener implicancias clínicas capaces de generar situaciones inesperadas durante procedimientos quirúrgicos de reconstrucción arterial o cateterismo vascular. El objetivo de este trabajo fue reportar el hallazgo de una variante anatómica de la arteria axilar, la cual puede tener implicancias clínicas y quirúrgicas. Se realizó un estudio de tipo descriptivo, en el cual se reportó una variación vascular unilateral encontrada durante una disección de rutina en un miembro superior derecho de un cadáver de sexo masculino. De la segunda porción de la arteria axilar se originó un tronco arterial común que daba origen a las arterias subescapular, circunfleja humeral anterior, circunfleja humeral posterior y braquial profunda. La tercera porción de la arteria axilar no emitía ramas. El tronco arterial común se originaba de la segunda porción, a 62,64 mm del inicio de la arteria axilar. Su longitud total era de 23,72 mm y su grosor de 6,1 mm. El calibre de las ramas originadas del tronco arterial común fue: arteria subescapular 5,1 mm, circunfleja humeral anterior de 1,66 mm, circunfleja humeral posterior 3,18 mm y braquial profunda 3,73 mm. La variante vascular detectada alteraba las relaciones anatómicas de la arteria axilar con el plexo braquial, generando una modificación en la posición de los fascículos y sus ramos terminales. Las variaciones anatómicas de la arteria axilar son frecuentes, conocerlas puede ser necesario durante procedimientos quirúrgicos o disecciones anatómicas.

The role of the axillary artery as a second access choice in TAVI procedures

Abstract With transcatheter aortic valve implantation (TAVI) technology expanding its indications for low-risk patients, the number of TAVI-eligible patients will globally grow, requiring a better understanding about the second-best access choice. Regarding the potential access sites, the transfemoral retrograde route is recognized as the standard approach and first choice according to current guidelines. However, this approach is not suitable in up to 10-15% of patients, for whom an alternative non-femoral access is required. Among the alternative non-femoral routes, the transaxillary approach has received increasing recognition due to its proximity and relatively straight course from the axillary artery to the aortic annulus, which provides a more accurate device deployment. Here we discuss some particular aspects of the transaxillary access, either percutaneously performed or by cutdown dissection.

Tratamento endovascular com endoprótese aórtica para aneurisma de artéria subclávia secundário à fístula arteriovenosa axilo-axilar traumática tardia / Endovascular treatment with aortic endoprostheses for subclavian artery aneurysm secondary to late traumatic axillary-axillary arteriovenous fistula

Resumo As fístulas arteriovenosas (FAVs) traumáticas envolvendo os vasos axilares e subclávios são incomuns e correspondem de 5 a 10% de todos os traumas arteriais. A anatomia complexa dessa região torna desafiador o tratamento desse segmento. Neste desafio terapêutico, descrevemos o caso de um homem de 73 anos, encaminhado por edema progressivo e úlcera no membro superior direito, com história pregressa de ferimento por arma de fogo na região infraclavicular direita há cerca de 50 anos. Foi realizada angiotomografia e identificou-se FAV axilo-axilar associada à tortuosidade e dilatação aneurismática de artéria subclávia a jusante. O paciente foi submetido à intervenção endovascular com endoprótese cônica (monoilíaca) 26 × 14 × 90 mm Braile® na artéria subclávia aneurismática, posterior à saída da artéria vertebral direita, e endoprótese monoilíaca 16 × 16 × 95 mm Excluder® com sobreposição na primeira prótese, apresentando resultado satisfatório. Portanto, descreve-se a possibilidade de utilização de endoprótese aórtica em situação incomum e de exceção, com sucesso.

Abstract Traumatic arteriovenous fistulas (AVFs) involving the axillary and subclavian vessels are uncommon and account for 5 to 10% of all arterial traumas. The complex anatomy of this region makes treatment of this segment challenging. In this therapeutic challenge, we describe the case of a 73-year-old man, referred for progressive edema and ulceration involving the right upper limb and with a history of gunshot wound to the right infraclavicular region about 50 years previously. Angiotomography was performed and an axillary-axillary AVF was found, associated with tortuosity and aneurysmatic dilation of the subclavian artery downstream. He underwent endovascular intervention and a conical (monoiliac) 26 × 14 × 90 mm Braile® endoprosthesis was used in the aneurysmatic subclavian artery, posterior to the exit of the right vertebral artery and a 16 × 16 × 95mm Excluder® monoiliac endoprosthesis was placed overlapping the first prosthesis, showing a satisfactory result. Therefore, the possibility of successfully using aortic endoprostheses in an unusual and exceptional situation is described.

Upper limb arterial pattern: clinical correlation and embryological perspective / Padrão arterial dos membros superiores: correlação clínica com perspectiva embriológica

Abstract Background Variations in the upper limb arterial pattern are commonplace and necessitate complete familiarity for successful surgical and interventional procedures. Variance in the vascular tree may involve any part of the axis artery of the upper limb, including the axillary artery and brachial artery or its branches, in the form of radial and ulnar arteries, which eventually supply the hand via anastomosing arches. Objectives To study the peculiarities of the arterial pattern of the upper limb and to correlate them with embryological development. Methods The entire arterial branching of forty-two upper limbs of formalin fixed adult human cadavers was examined during routine dissection for educational purposes, conducted over a 3-year period in the Department of Anatomy, Lady Hardinge Medical College, New Delhi. Results The study found: 1) One case in which a common trunk arose from the third part of the axillary artery, which immediately splayed into four branches (2.4%); 2) High division of the brachial artery into ulnar and radial arteries, in 3 cases (7.1%); 3) Pentafurcation of the brachial artery into ulnar, interosseus, radial, and radial recurrent arteries and a muscular twig to the brachioradialis in 1/42 cases (2.4%); 4) Incomplete Superficial Palmar arch in 3/42 cases (7.1%); and 5) Presence of a median artery in 2/42 case(4.8%) Conclusions This study observed and described the varied arterial patterns of the upper limb and identified the various anomalous patterns, supplementing the surgeon's armamentarium in various surgical procedures, thereby helping to prevent complications or failures of reconstructive surgeries, bypass angiography, and many similar procedures.

Resumo Contexto As variações no padrão arterial dos membros superiores são comuns e, assim, necessitam de total familiaridade para que os procedimentos cirúrgicos e de intervenção sejam bem-sucedidos. A variância na árvore vascular pode envolver qualquer parte da artéria axial dos membros superiores, incluindo a artéria axilar, a artéria braquial ou os seus ramos, na forma das artérias radial e ulnar, as quais, em algum momento, suprem as mãos através dos arcos anastomosados. Objetivos Avaliar as peculiaridades do padrão arterial dos membros superiores e correlacioná-las ao desenvolvimento embriológico. Métodos Foram examinados os ramos arteriais completos de 42 membros superiores de cadáveres adultos conservados em formalina, os quais eram rotineiramente dissecados para fins educacionais durante 3 anos no Departamento de Anatomia Lady Hardinge Medical College, Nova Delhi. Resultados O estudo apresentou cinco desfechos. 1. Foi constatado um caso em que um tronco comum surgiu da terceira parte da artéria axilar que imediatamente se disseminou em quatro ramos (2,4%). 2. Houve divisão maior da artéria braquial em artérias ulnar e radial em três casos (7,1%). 3. Em um caso, ocorreu pentafurcação da artéria braquial em ulnar, interóssea, radial, radial recorrente e de um galho muscular em braquiorradial (2,4%). 4. Foi constatado arco palmar superficial incompleto em três dos 42 casos (7,1%). 5. Foi observada a presença da artéria mediana em 2 dos 42 casos (4,8%). Conclusões Este estudo compreende o padrão arterial do membro superior e identifica os diversos padrões anômalos para agregar ao arsenal terapêutico de cirurgiões para diversos procedimentos cirúrgicos, com o objetivo de combater quaisquer complicações ou falhas de cirurgias reconstrutivas, de angiografias de cirurgias de revascularização e muitas outras.

Comparison of femoral and axillary artery cannulation in acute type a aortic dissection surgery

Abstract Introduction: One of the most important points of the acute type A aortic dissection surgery is how to perform cannulation regarding cerebral protection concerns and the conditions of arterial structures as a pathophysiological consequence of the disease. Objective: In this study, femoral and axillary cannulation methods were compared in acute type A aortic dissection operations. Methods: The study retrospectively evaluated 52 patients who underwent emergency surgery for acute type A aortic dissection. Patients without malperfusion according to Penn Aa classification were chosen for preoperative standardization of the study groups. The femoral arterial cannulation group was group 1 (n=22) and the axillary arterial cannulation group was group 2 (n=30). The groups were compared in terms of perioperative and postoperative results. Results: There was no statistically significant difference in terms of preoperative data. In terms of postoperative parameters, especially early mortality and new-onset cerebrovascular event, there was no statistically significant difference. Mortality rates in group 1 and group 2 were 13.6% (n=3) and 10% (n=3), respectively (P=0.685). Postoperative new-onset cerebral events ratio was found in 5 (22.7%) in the femoral cannulation group and 6 (20%) in the axillary cannulation group (P=0.812). Conclusion: Both femoral and axillary arterial cannulation methods can be safely performed in patients with acute type A aortic dissection, provided that cerebral protection strategies should be considered in the first place. The method to be performed may vary depending on the patient's current medical condition or the surgeon's preference.

A rare variation of suprascapular artery originated from the axillary artery / Una rara variación de la arteria supraescapular originada de la arteria axilar

SUMMARY: The suprascapular artery (SSA) has been identified to be of clinical relevance to clavicular fracture, suprascapular neuropathy and surgical intervention of shoulder. Thus its origin and course have been intensively studied. In this case, we found a unilateral variation of the suprascapular artery, originating from the 1st segment of axillary artery, and sequentially penetrating the upper trunk of brachial plexus, passing through the suprascapular notch under the superior transverse scapular ligament. This case will be helpful to clinical management in cervical and shoulder region.

RESUMEN: Se ha identificado que la arteria supraescapular (ASS) tiene relevancia clínica en la fractura clavicular, la neuropatía supraescapular y la intervención quirúrgica del hombro. En consecuencia, su origen y su curso han sido ampliamente estudiados. En este caso, encontramos una variación unilateral de la arteria supraescapular, originada en el primer segmento de la arteria axilar, y que penetraba secuencialmente en el tronco superior del plexo braquial, pasando a través de la incisura supraescapular debajo del ligamento escapular transverso superior. Este caso será útil para el manejo clínico en la región cervical y del hombro.

Lesión traumática del nervio axilar identificada luego de la reparación del manguito rotador / Traumatic injury of the axillary nerve identified after rotator cuff repair

Introducción: La prevalencia del dolor de hombro oscila entre el 6,7% y el 66,7%; los trastornos del manguito rotador y especialmente la ruptura pueden alcanzar una prevalencia del 22,1%. Debido a los importantes avances y estudios en la reparación de esta lesión, la cirugía artroscópica ha permitido una mejor identificación, visualización y clasificación, y un mejor manejo de los pacientes. Además, la ruptura del manguito rotador o la fractura de la tuberosidad mayor del húmero incrementan el riesgo de lesión nerviosa (riesgo relativo -1,9), más significativa en pacientes >60 años. Se presenta a un paciente con ruptura postraumática del manguito rotador, quien requirió reparación artroscópica mínimamente invasiva, con evolución posoperatoria estacionaria y diagnóstico de lesión del nervio axilar, sin recuperación autolimitada atribuida a luxación anterior e inestabilidad secundaria al trauma inicial. Conclusiones: La lesión del nervio axilar es más frecuente que lo esperado y, en muchas ocasiones, la identificación temprana se pasa por alto debido a la alta asociación con otras lesiones. Por lo tanto, el diagnóstico y el manejo oportunos requieren mucho cuidado por parte del médico tratante. Nivel de Evidencia: IV

Introduction: The prevalence of shoulder pain varies between 6.7% and 66.7%; whereas rotator cuff disorders-especially rupture-can reach a prevalence of 22.1%. Due to the important advances and studies in the repair of this injury, arthroscopic surgery has allowed a better identification, visualization and classification, as well as a better handling of the patients. In addition, rotator cuff ruptures or greater tuberosity fractures increase the risk of nerve injury (relative risk -1.9), which is more significant in patients >60 years old. We discuss the case of a patient with post-traumatic rotator cuff rupture who required minimally invasive arthroscopic repair. No weight-bearing was allowed during the postoperative period. Patient presented a non-self-limited axillary nerve injury secondary to anterior dislocation and resulting instability after the original trauma. Conclusions: Axillary nerve injuries are more common than expected and, in many cases, early identification is not possible due to its high rate of association with other injuries. Therefore, treating physicians must be very careful in order to achieve a timely diagnosis and management of the patient. Level of Evidence: IV

Innominate vs. axillary artery cannulation in aortic surgery: a systematic review and meta-analysis

Abstract Objective: To investigate whether axillary artery cannulation has supremacy over innominate artery cannulation in thoracic aortic surgery. Methods: A comprehensive search was undertaken among the four major databases (PubMed, Excerpta Medica dataBASE [EMBASE], Scopus, and Ovid) to identify all randomized and nonrandomized controlled trials comparing axillary to innominate artery cannulation in thoracic aortic surgery. Databases were evaluated and assessed up to March 2017. Results: Only three studies fulfilled the criteria for this meta-analysis, including 534 patients. Cardiopulmonary bypass time was significantly shorter in the innominate group (P=0.004). However, the innominate group had significantly higher risk of prolonged intubation > 48 hours (P=0.04) than the axillary group. Further analysis revealed no significant difference between the innominate and axillary groups for deep hypothermic circulatory arrest time (P=0.06). The relative risks for temporary and permanent neurological deficits as well as in-hospital mortality were not significantly different for both groups (P=0.90, P=0.49, and P=0.55, respectively). Length of hospital stay was similar for both groups. Conclusion: There is no superiority of axillary over innominate artery cannulation in thoracic aortic surgery in terms of perioperative outcomes; however, as the studies were limited, larger scale comparative studies are required to provide a solid evidence base for choosing optimal arterial cannulation site.

Endovascular repair of a penetrating axillary artery injury

Abstract We report a 16-year-old boy who sustained a gunshot injury on his upper left side of the chest that resulted in an injury to the left axillary artery and was treated with endovascular repair. An endovascular repair has been increasingly accepted for the management of hemorrhage in critically ill trauma patients; using covered endovascular stents provides an alternative modality for both controlling hemorrhage and preserving flow.

Carpal Tunnel Syndrome Caused by Persistent Median Artery and Bifid Median Nerve in an Adolescent / 대한정형외과학회잡지

Carpal tunnel syndrome is rare in children. When it does occur in children, the most common causes reported are mucopolysaccharidosis and mucolipidosis. The median artery is a transitory vessel that develops from the axillary artery in early embryonic life and does not normally survive until postfetal life. In a small percentage of individuals, however, it persists into adulthood and is frequently accompanied by a bifid median nerve. A persistent median artery can be a cause of carpal tunnel syndrome in adults, but it is extremely rare in children and adolescents. This paper reports a case of a carpal tunnel syndrome caused by a persistent median artery and bifid median nerve in a 13-year-old girl.

Reparación de sección de arteria axilar por trauma vascular secundario a herida por arma blanca: a propósito de un caso / Repair of axillary artery section due to vascular trauma secondary to stab wounds: a case report

Objetivo: Presentar un caso clínico y discutir el manejo del trauma de arteria axilar y revisar la literatura actual. Caso Clínico: se presenta el caso de un paciente con lesión de arteria axilar, que es traído en shock hipovolémico al Servicio de Emergencias de nuestro hospital. En pabellón, se aprecia sección incompleta de la segunda porción de la arteria axilar. Se controla y repara con anastomosis primaria término-terminal. En su posoperatorio evoluciona de forma satisfactoria. Discusión: El manejo del trauma vascular debe ser metódico y multidisciplinario. Los signos duros de trauma vascular son indicación de exploración quirúrgica inmediata. Los pacientes con signos blandos pueden complementarse con imágenes. En una sección incompleta de arteria axilar, la anastomosis término-terminal ha mostrado buenos resultados. Conclusiones: las lesiones de arteria axilar en el contexto de traumas son infrecuentes. Su manejo necesita de un alto índice de sospecha, un enfoque multidisciplinario y un acceso quirúrgico adecuado al contexto.

Objective: To present a clinical case and discuss the management of axillary artery trauma and to review current literature. Clinical case: Male patient with axillary artery injury, who is brought in hypovolemic shock to the Emergency Department. Surgical findings demonstrated an incomplete section of the second portion of the axillary artery which was repaired with primary end-to-end anastomosis. Postoperatively, the patient evolves without pain and is discharged. Discussion: The management of vascular trauma should be methodical and multidisciplinary. Hard signs of vascular trauma mandate immediate surgical exploration. Patients with soft signs may need further evaluation with images. In an incomplete section of the axillary artery the end-to-end anastomosis has shown good results. Conclusions: Axillary artery lesions in the context of trauma are infrequent. Its management requires a high index of suspicion, a multidisciplinary approach and adequate surgical access.

Variations in the origin and course of the suprascapular artery: case report and literature review / Variações na origem e percurso da artéria supraescapular: relato de caso e revisão da literatura

Abstract The suprascapular artery is normally a branch of the thyrocervical trunk of the subclavian artery. During dissection of the left upper limb of a female cadaver, aged 70 years and fixed in 10% formalin solution, the suprascapular artery was observed aberrantly arising from the first part of the axillary artery. Later, it coursed obliquely behind the clavicle bone and brachial plexus to reach the suprascapular notch, where it was accompanied by the suprascapular nerve. Then, both suprascapular nerve and artery anomalously traversed beneath the transverse scapular ligament. It then irrigated the supraspinatus muscles and took part in the anastomosis around the scapula. On the contralateral side there was no abnormality. Variations in the origin and course of suprascapular artery are of immense value to orthopedic and vascular surgeons, angiographists, and anatomists.

Resumo A artéria supraescapular normalmente se apresenta como um ramo do tronco tireocervical da artéria subclávia. Durante a dissecção do membro superior esquerdo de um cadáver do sexo feminino com idade de 70 anos fixado em solução de formol 10%, observou-se que a artéria supraescapular tinha origem aberrante na primeira parte da artéria axilar. Mais adiante, a artéria cursava obliquamente por trás da clavícula e plexo braquial até atingir a incisura supraescapular, onde era acompanhada pelo nervo supraescapular. A partir daí, tanto o nervo quanto a artéria supraescapulares atravessavam de forma anômala por baixo do ligamento transverso da escápula. Neste ponto, irrigavam os músculos supraespinhosos e faziam parte da anastomose em torno da escápula. No lado contralateral, não havia anormalidade. Variações na origem e percurso da artéria supraescapular são de grande valor para cirurgiões ortopédicos e vasculares, angiografistas e anatomistas.

Minimally Invasive Redo Mitral Valve Replacement under Fibrillatory Arrest in a Patient with a Calcified Aorta and Patent Previous Bypass Grafts

A 73-year-old woman who underwent combined bioprosthetic mitral valve replacement, tricuspid ring annuloplasty, and coronary artery bypass grafting 12 years previously visited our clinic due to aggravated dyspnea caused by structural valve deterioration of the mitral prosthesis. Because aortic or femoral artery cannulation and cross-clamping would have a high risk of stroke owing to severe calcification of the ascending aorta and ilio-femoral vessels, and because there was a risk of redo sternotomy due to the patent bypass grafts, a comprehensive approach including axillary artery cannulation, a minimally invasive right thoracotomy approach, and a clampless hypothermic fibrillatory arrest technique was used during redo mitral valve replacement.

Variations in Branching Patterns of the Anterior Circumflex Humeral Artery / 계명의대학술지

Anatomic variations in the branching pattern of the axillary artery are common and have been studied by many authors. The origin of the anterior circumflex humeral artery is also various and its association with other variations has been focused recently. This study identified the origin of the anterior circumflex humeral artery, the communication between the musculocutaneous and median nerves, and the third head of the biceps brachii muscle, and then their associations were examined. Axillae of 75 cadavers were dissected and these variations were collected. The anterior circumflex humeral artery arose directly from the third parts of the axillary artery in 82.0% of upper limbs. It also arose as common stem for both humeral arteries in 7.3% of the third part of the axillary artery and in 5.3% of the subscapular artery, respectively. The anterior circumflex humeral artery was absent in 2.7% and two anterior circumflex humeral artery was found in 1.3% of limbs. The communication between the musculocutaneous and median nerves and the third head of the biceps brachii muscle were found in 32.0% and 16.0% of upper limbs, respectively. These variations were not statistically associated with each other. These results may provide deep knowledge about the anatomy of the anterior circumflex humeral artery and contribute to explain its clinical implications.

Variation of the Axillary Arch in Korean Cadaver / 체질인류학회지

Axillary arch is relatively common variation of muscle in the axilla. There were several attentions on axillary arch due to its anatomical and surgical importance. During educational dissection, a variant muscle was found in right arm of 68-year-old female cadaver. The variation of muscle originated from the lateral edge of the latissimus dorsi muscle as muscular form. And then, it crossed the axillary artery and median nerve as tendinous form. Finally it became wide as muscular form and inserted into the pectoralis major. We reported this variant muscle and discussed its clinical significances.

Brachial plexus injury secondary to pseudoaneurysm of axillary artery after glenohumeral dislocation: case report / Lesão de plexo braquial secundária a pseudoaneurisma de artéria axilar após luxação glenoumeral: relato de caso

ABSTRACT Lesions of the axillary artery and consequent compression of the brachial plexus are extremely rare in patients with glenohumeral dislocation and may have greatly varying clinical manifestations. This joint is one of the most affected by dislocation in the human body, accounting for approximately 45% of cases. Less than 1% of patients with shoulder dislocation have vascular complications; however, when there is damage in the axillary artery, the incidence of associated brachial plexus injury is 27% to 44%. The authors report on a case of brachial plexus compression by an axillary artery pseudoaneurysm after a glenohumeral dislocation, aiming to highlight the existence of this association, in order to make an early diagnosis and avoid serious complications, such as neurologic injury.

RESUMO As lesões de artéria axilar e consequente compressão de plexo braquial são extremamente raras em pacientes com luxação de glenoumeral e podem ter manifestações clínicas bastante variadas. Essa articulação é uma das mais acometidas por luxação do corpo humano, representando cerca de 45% dos casos. Menos de 1% dos pacientes com luxação de ombro apresentam complicações vasculares; no entanto, quando há lesão da artéria axilar, a incidência de lesão de plexo braquial associada é de 27% a 44%. Relatamos um caso de compressão do plexo braquial por um pseudoaneurisma de artéria axilar após uma luxação glenoumeral. O objetivo é lembrar a existência dessa associação, a fim de diagnosticá-la precocemente e evitar complicações graves, como a lesão neurológica.

Abnormal origin of posterior circumflex humeral artery and subscapular artery: case report and review of the literature / Origem anômala das artérias circunflexa posterior do úmero e subescapular: relato de caso e revisão de literatura

The subscapular, anterior circumflex, and posterior circumflex arteries arise from the third part of the axillary artery. During dissection of the right upper limb of the cadaver of a 70-year-old male, a common trunk was observed arising from the third part of the axillary artery which, after traveling for 0.5 cm, bifurcated into subscapular and posterior circumflex humeral arteries. The common trunk was crossed anteriorly by the radial nerve. The medial nerve was formed by medial and lateral roots on the medial side of the third part of the axillary artery, remaining medial to the brachial artery up to the cubital fossa and then following its usual course thereafter. Awareness of the vascular variations observed in the present case is important when conducting surgical procedures in the axilla, for radiologists interpreting angiographs, and for anatomy-pathologists studying rare findings

As artérias subescapular, circunflexa anterior e circunflexa posterior se originam da terceira parte da artéria axilar. Durante a dissecção de membro superior direito de um cadáver humano com 70 anos de idade, do sexo masculino, um tronco comum foi observado originando-se da terceira parte da artéria axilar, após um percurso de 0,5 cm, bifurcando-se em artéria subescapular e artéria circunflexa posterior do húmero. O tronco comum era cruzado anteriormente pelo nervo radial. O nervo medial era formado por raízes medial e lateral, no lado medial da terceira parte da artéria axilar, permanecendo em posição medial à artéria braquial até a fossa cubital e seguindo seu curso usual a partir de então. Conhecimento das variações vasculares observadas neste caso é importante ao executar procedimentos cirúrgicos na axila, para radiologistas que interpretam radiografias, e também para anatomo-patologistas que estudam achados raros

A study of anatomical variations of median nerve formation and its relation to the arteries in the axilla and arm / Estudio de las variaciones anatómicas en la formación del nervio mediano y su relación con las arterias de la axila y el brazo

Variations of the peripheral nerve formation, communication and distribution are clinically important because such knowledge can be used for proper planning of surgeries and evaluating effects of nerve injuries and clinical imaging. Median nerve is known to have several such variations. However studies done on median nerve in Sri Lankan subjects are spars. The objective of this study was to find out anatomical variations of the median nerve with regards to its variations in roots and relations to the arteries in the axilla and arm. The study was done using 98 upper limbs of 49 formalin fixed cadavers. They were dissected and anatomy of the median nerve formations was studied focusing its variations of the roots and relation to the arteries. Anatomical variations of MN formation were observed in 33 (33.67 %) upper limbs with 4 bilateral and 25 unilateral variations. These variations were classified broadly in to two groups, variations of roots (15.3 %) and variation of arterial relations (18.37 %). There were three types of numerical variations (9.18 %) and three types of morphological variations (6.12 %) of roots. The median nerve was found to form in relation to the 2nd part of the axillary artery in 6.12 %, abnormal relation to the 3rd part of the axillary artery in 2.04 %, normal relation to the 3rd part of the axillary artery in 81.63 %, and brachial artery in 10.2 % of the specimens. The current study highlights the presence of different anatomical variations at median nerve formation with regards to its roots and arterial relations and describes three rare forms of anomalies which were not found on literature survey.

Las variaciones de la comunicación, formación y distribución del nervio periférico son clínicamente importantes para la planificación adecuada de las cirugías y para evaluar los efectos de las lesiones nerviosas y la imagen clínica. En el nervio mediano se han observado varias de estas variaciones. Sin embargo, son escasos los estudios realizados del nervio mediano en sujetos de Sri Lanka. El objetivo de este estudio fue conocer las variaciones anatómicas del nervio mediano con respecto a sus raíces y las relaciones con las arterias axilar y braquial. El estudio se realizó utilizando 98 miembros superiores de 49 cadáveres fijados con formalina. Se disecó y se estudió la anatomía de las formaciones de los nervios medianos, enfocando sus variaciones a nivel de las raíces y las relaciones con las arterias. Se observaron variaciones anatómicas de la formación de nervio mediano en 33 miembros superiores (33,67 %) con 4 variaciones bilaterales y 25 unilaterales. Estas variaciones se clasificaron ampliamente en dos grupos, variaciones de raíces (15,3 %) y variación de las relaciones arteriales (18,37 %). Existen tres tipos de variaciones numéricas (9,18 %) y tres tipos de variaciones morfológicas (6,12 %) de las raíces. Se encontró que el nervio mediano se formaba en relación con la 2 parte de la arteria axilar en el 6,12 %, relación anormal con la 3 parte de la arteria axilar en 2,04 %, relación normal con la 3 parte de la arteria axilar en el 81 ,63 % y braquial en el 10,2 % de los especímenes. El presente estudio señala la presencia de diferentes variaciones anatómicas en la formación del nervio mediano con respecto a sus raíces y relaciones arteriales y describe tres anomalías raras que no se encontraron en la investigación bibliográfica.

Origen alto de la arteria radial (Arteria braquirradial superficial): Presentación de 3 casos / High origin of the radial artery (superficial brachialarterial artery): Presentation of 3 cases

Se presentan tres casos de nacimiento alto de la arteria radial, todos en el miembro derecho, uno a nivel del tercio superior de la arteria braquial, el segundo caso a nivel del tercio medio de la misma y en el tercer caso el nacimiento de la arteria radial se produce a nivel de la arteria axilar. En todos los casos tienen un trayecto superficial en el brazo y antebrazo. En la mano forman el arco palmar arterial profundo de manera habitual. Estos casos representan el 7,5% de los 40 miembros disecados. El origen alto de la arteria radial es la variante más frecuente dentro de las anomalías del árbol arterial del miembro superior. Su importancia radica en el aumento de los procedimientos percutáneos sobre la arteria radial en cateterismos coronarios y en el cada vez más utilizado colgajo radial en las cirugías reconstructivas. Su trayecto superficial favorece los traumatismos y la confusión con venas, situación que puede ocasionar inyecciones medicamentosas accidentales en estas arterias con sus graves consecuencias.

We present three cases of high birth of the radial artery, all on the right limbone at the upper third of the brachial artery, the second at the middle third of the artery, and in the third case the radial artery arises at the level of the axillary artery. In all cases they have a superficial path in the arm and forearm. In the hand they form the deep arterial arch of the palmar in the usual way. These cases represent 7.5% of the 40 dissected members. The high birth of the radial artery is the most frequent variant within the arterial tree anomalies of the upper limb. Its importance lies in the increase of the percutaneous procedures on the radial artery in coronary catheterisms and in the increasingly used radial flap in the reconstructive surgeries. Its superficial pathway favors trauma and confusion with veins, a situation that can cause accidental drug injections in these arteries with their serious consequences.