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.

Arteria braquial superficial bilateral. una variación anatómica infrecuente con implicancias clínicas y quirúrgicas / Bilateral superficial brachial artery. a rare anatomical variation with clinical and surgical implications

Las variaciones del sistema arterial en el miembro superior son relevantes debido a la gran cantidad de procedimientos diagnósticos, invasivos y terapéuticos realizados en la actualidad. Reportamos una variante poco frecuente de la arteria braquial superficial (ABS) encontrada bilateralmente en los miembros superiores. En ambos miembros la ABS descendió superficial y lateral al nervio mediano y medial a la cabeza corta del músculo bíceps braquial. La ABS derecha terminó en la fosa cubital se unió a la arteria braquial en un tronco común, una variación anatómica rara de tipo isla, mientras que la ABS izquierda terminó en el antebrazo como arteria radial. La presencia unilateral de la ABS se ha informado con una frecuencia relativa, pero una variación bilateral es extremadamente rara. La relevancia de la embriología, incidencia y clínica de esta variación anatómica se discuten.

Variations of the upper limb arterial system are an important consideration due to the large number of invasive, diagnostic and therapeutic procedures performed in this region. We report a rare variant of the superficial brachial artery (SBA) found bilaterally in the upper limbs. In both limbs the SBA desending superficial and lateral of median nerve, and medial to the short head of bicep brachii muscle. Right SBA finished in the cubital fossa joined the deep brachial artery in a common trunk, a rare anatomical variation of island type, while the left SBA finished in the forearm and radial artery. The unilateral presence of the SBA reported with relative frequency, but a bilateral variation is extremely rare. The relevance of embryology, and clinical incidence of this anatomical variation are discussed.

Neuro-Vascular Variation in Axilla.

A variation in the branching pattern of third part of axillary artery was observed in the right upper limb of an adult male cadaver during routine dissection. The axillary artery gave a large abnormal arterial trunk. This trunk branched into anterior circumflex humeral, subscapular and profunda brachii artery. Subscapular trunk further divided into posterior circumflex humeral and circumflex scapular artery. There was abnormal formation of median nerve by two roots, anterior to abnormal arterial trunk. Medial root of median nerve was present behind axillary artery. Ulnar nerve was also formed around the abnormal trunk by medial and lateral roots. This abnormality might cause neurovascular compression in the upper limb like compression of abnormal arterial trunk by two roots of median nerve and compression of medial root of median nerve by axillary artery.

Brachial artery variation: a rare pattern

Unlike venous system, variations in arterial anatomy are less frequent and most of them affect visceral arteries.In limbs, variations of the brachial artery are the most reported and at least six different patterns have beendescribed so far. The commonest is the superficial brachial artery, which lies superficially to the median nerve.Much less prevalent are the high origin of the radial artery (brachioradial artery) or the existence of a doubledbrachial artery (accessory brachial artery). We present a previously undescribed pattern of brachial arteryvariation. During dissection of the right upper limb of a 60-year-old male embalmed cadaver, we found thebifurcation of the brachial artery in the proximal portion of the middle third of the arm. Its medial branchreaches the medial aspect of the arm, posterior to the median nerve. Afterwards, this medial branch redirectslaterally and crosses again the median nerve, this time lying anterior to the nerve until it reaches the lateralaspect of the arm. At the elbow level, the medial branch originates the radial artery. The lateral branch of thebrachial artery remains lateral to the median nerve, continues as ulnar artery, and originates the interosseusartery.

Entrapment of the median nerves and brachial arteries in the lower arms bilaterally and additional origin of biceps brachii muscle: case report / Compresión bilateral del nervio mediano y de la arteria braquial en la parte distal del brazo y origen adicional del músculo bíceps braquial: reporte de caso

Neuro-vascular entrapments associated with variations observed in the origins of muscles in the arm are not uncommon. Though additional heads of biceps brachii muscle and extra fibres of brachialis muscles have been demonstrated earlier, bilateral additional heads of the biceps are rarely seen, especially with entrapment of the median nerve and the brachial arteries in both the arms. The present study reports conspicuous heads of the biceps brachii originating extensively from the medial inter-muscular septum, sharing its origin with the brachialis muscle. The extra origins of the muscle formed long musculo-aponeurotic tunnels. The tunnels measured eight centimeters in length extending from the lower arm to the cubital-fossa. Both the median nerve and the brachial arteries passed through the tunnel. The lower aspect of the left tunnel exhibited origins of fibres belonging to the superficial flexors of the forearm. The neuro-vascular structures did not give any branches in the tunnel. Awareness of such variations can aid clinicians in diagnosing and treating such neuropathies and vascular compromise.

No es infrecuente observar atrapamientos neuro-vasculares asociados con variaciones en el origen de los músculos del brazo. A pesar de haberse observado cabezas adicionales del músculo bíceps braquial y fibras extra del músculo braquial raramente estas cabezas adicionales bilaterales han sido causantes de la compresión del nervio mediano y de la arteria braquial. En este trabajo presentamos las cabezas del músculo bíceps braquial originándose en gran parte en el tabique intermuscular medial compartiendo su origen con el músculo braquial. Los orígenes adicionales del músculo forman largos túneles músculo fasciales. Los túneles miden 8 cm de longitud, y se extienden desde la parte inferior del brazo hasta la fosa cubital. Tanto el nervio mediano como la arteria braquial pasan por el túnel. La parte inferior del túnel izquierdo dio origen a fibras pertenecientes al músculo flexor superficial del antebrazo. Las estructuras neurovasculares no otorgaron colaterales en el túnel. El conocimiento de estas variaciones puede ayudar a los clínicos en el diagnóstico y el tratamiento de neuropatías y compromiso vascular.

Case report of high origin of radial, ulnar, and profunda brachii arteries, its clinical implications and review of the literature / Relato de caso de origem alta das artérias radial, ulnar e braquial profunda, suas implicações clínicas e revisão de literatura

Arterial variations in the arm are of potential clinical implications as it is a frequent site of injury and also involved in many surgical and invasive procedures. During a dissection of the right upper extremity, an abnormal high origin of the radial and ulnar arteries was found. The brachial artery had a very short segment without any branches, divided into the radial and ulnar arteries at the upper third of the arm. The course and branching pattern of these radial and ulnar arteries in the arm are discussed. It was also observed that the profunda brachii artery was represented by two separate branches arising from the posterior circumflex humeral artery. Accurate knowledge of these variation patterns is of considerable clinical importance in the conduct of reparative surgeries around the shoulder and fracture management of the humerus. These additional data of arterial anomalies to contemporary anatomical literature are of interest to clinicians, in particular vascular and plastic surgeons and radiologists.

As variações arteriais no braço têm potenciais implicações clínicas já que o braço é um sítio de lesões frequentes, além de estar envolvido em muitos procedimentos cirúrgicos e invasivos. Durante a dissecção da extremidade superior direita, uma origem alta anormal das artérias radial e ulnar foi encontrada. A artéria braquial apresentava um segmento muito curto sem quaisquer ramos, dividindo-se nas artérias radial e ulnar no terço superior do braço. O curso e o padrão de ramificação das artérias radial e ulnar no braço são discutidos. Também se observou que a artéria braquial profunda estava representada por dois ramos separados, surgindo da artéria umeral circunflexa posterior. O conhecimento preciso sobre esses padrões de variação é de considerável importância na realização de cirurgias reparadoras na região do ombro e no manejo de fraturas de úmero. Estes dados adicionais sobre as anomalias arteriais para a literatura anatômica contemporânea são de grande interesse para os médicos, especialmente para cirurgiões plásticos e vasculares e radiologistas.

Abnormal branching pattern of the axillary artery and its clinical significance / Patrón de ramificación anormal de la arteria axilar y su significado clínico

The increasing use of invasive diagnostic and interventional procedures in cardiovascular diseases makes it important that the type and frequency of vascular variations are well documented and understood. Sound knowledge of neurovascular variations is important for surgeons who remove axillary lymph nodes, to anesthesiologists, and orthopedic surgeons, considering the frequency of procedures done in this region. An unusual variation in the branching pattern of axillary artery was observed on the left side of a 60 year old female cadaver. In the present case the course and distribution of the first and second part of the axillary artery were normal. But a rare case of unusual origin of subscapular, anterior and posterior circumflex humeral, profunda brachii artery and ulnar collateral arteries from a common trunk were found on the left side during routine dissection. This common trunk was found arising from the third part of the axillary artery and at its commencement it was found passing between the two roots of the median nerve. Cases with this kind of variations should be examined or operated carefully during surgical or electrophysiological procedures.

El incremento del uso de diagnósticos invasivos y procedimientos de intervención en las enfermedades cardiovasculares hace que sea importante que el tipo y la frecuencia de las variaciones vasculares estén bien documentados y entendidos. Un buen conocimiento de las variaciones neurovasculares es importante para los cirujanos que extirpan linfonodos axilares, para anestesiólogos y cirujanos ortopédicos, considerando la frecuencia de los procedimientos realizados en esta región. Una inusual variación en el patrón de ramificación de la arteria axilar se observó en el lado izquierdo de un cadáver de sexo femenino de 60 años de edad. En el presente caso, el curso y la distribución de la primera y segunda parte de la arteria axilar fueron normales. Sin embargo, fue encontrado en el lado izquierdo, durante la disección de rutina, un caso raro, de origen inusual, de las arterias subescapular cirunflejas humerales anterior y posterior, braquial profunda y arterias colaterales ulnares desde un tronco común. Este tronco común se encontró derivado de la tercera parte de la arteria axilar y en su comienzo se comprobó que pasaba entre las dos raíces del nervio mediano. Los casos con este tipo de variaciones deben ser examinados u operados cuidadosamente durante procedimientos quirúrgicos o electro fisiológicos.

Unilateral double axillary and double brachial arteries: embryological basis and clinical implications / Arterias Axilar y Braquial Dobles Unilaterales. Bases Embriológicas e Implicaciones Clínicas

Este reporte describe la presencia de las arterias axilar y braquial duplicadas en el lado derecho de un cadáver adulto de sexo masculino. La arteria axilar derecha se bifurcó en arterias axilares I y II, localizadas posteriormente al músculo pectoral menor. Ambas arterias, con sus respectivas ramas atravesaron bajo el músculo redondo mayor y continuaron como arterias braquiales I y II, respectivamente. La arteria axilar I, que se continuó como arteria braquial I, tuvo un trayecto superficial y tortuoso, mientras que la arteria axilar II fue de poco calibre y de localización profunda. Las arterias toracoacromial, torácica lateral y subescapular se originaron de la arteria axilar I. La arteria torácica superior se originó de la arteria toracoacromial. Las arterias circunflejas humerales anterior y posterior se originaron desde la arteria axilar II. La arteria braquial profundase originó de la arteria braquial II, mientras que a nivel de la línea intercondílea, la arteria ulnar se originó de la arteria braquial I. En la fosa cubital, la arteria braquial I se dividió en arterias radial e interósea común, mientras que la arteria braquial II terminó anastomosándose con la arteria braquial I. Las arterias ulnar, radial e interóseas común continuaron como arterias independientes y tuvieron un trayecto y distribución normales en el antebrazo. La persistencia de arterias axilar y braquial dobles tiene una base embriológica, pudiendo ser de interés para la embriología experimental. El conocimiento de estas variaciones arteriales múltiples, como el presente caso, es de importancia fundamental durante la medición de flujo en los vasos sanguíneos a través de Doppler, para el diagnóstico clínico y manejo quirúrgico de enfermedades que afectan al miembro superior.

This report presents double axillary and double brachial arteries on the right side of an adult male cadaver. In this case, the right axillary artery bifurcated into axillary artery I and axillary artery II posterior to the pectoralis minor muscle. Both the axillary arteries with their branches traversed upto lower border of teres major muscle and continued further as seperate entities into the cubital fossa as brachial artery I and brachial artery II respectively. The axillary artery I which continued as brachial artery I was superficial and tortuous in its course, while the axillary artery II was slender and deeply situated. The thoraco-acromial, lateral thoracic and subscapular arteries took origin from axillary artery I. The superior thoracic artery was seen arising from the thoraco-acromial artery. The anterior and posterior circumflex humeral arteries arose from axillary artery II.The profunda brachii artery was given off by the brachial artery II, while at the level of intercondylar line, the ulnar artery was given off by brachial artery I. In the cubital fossa, the brachial artery divided into radial and common interosseous artery, while the brachial artery II ended by anastomosis with brachial artery I. The ulnar, radial and common interosseous arteries continued as separate entities and exhibited a normal course and distribution in the forearm.The hypothesis for the embryological basis of persistence of double axillary and double brachical arteries may be useful for experimental embryology. The knowledge of such multiple arterial variations as in the present case is of immense significance during Doppler scanning of blood vessels for clinical diagnosis and surgical management of diseases of superior extremity.

Variaciones anatómicas en las arterias de las extremidades superiores / Arterial variations anatomic of the upper extremities

El siguiente reporte muestra múltiples variaciones arteriales que pudimos encontrar en el miembro superior (art. Axilaris y art. Braquialis y ramas colaterales). Realizamos la disección y observación de 40 extremidades superiores pertenecientes a 21 cadáveres adultos de ambos sexos; los cuales fueron preparados por la Cátedra de anatomía Normal del Instituto Anatómico "José Izquierdo", Escuela "Luis Razetti" de la Facultad de Medicina de la UCV, con la inmerción en una solución de formol, glicerina y fenol al 10 por ciento. Como resultados importantes se presenta una variabilidad anatómica del 17,5 por ciento (7 casos), un 15 por ciento (6 casos) fue hallado en la art. Axilar y el 2,5 por ciento (un caso) en la art. Braquial