A case of potentially lethal vascular variation in association with palmaris profundus muscle / 대한해부학회지

Arterial variations in upper limbs are often reported commonly. Superficial arterial variations accounting for 4.2% of all arterial variations are hazardous during any invasive procedures of the upper limb, from routine intravenous injections to surgeries. Arterial variations are usually associated with inverted or absent palmaris longus. Palmaris profundus, a rare anomalous variation of palmaris longus has been reported in carpal tunnel syndrome as its tendon was associated with median nerve in the carpal tunnel. The authors reported a unique variation in the upper limb arterial pattern—the presence of bilateral superficial brachioulnar artery associated with unilateral palmaris profundus muscle and an abnormal radicle of musculocutaneous nerve to the median nerve in the left side.

Superficial brachioulnar artery and its clinical significance / 대한해부학회지

The authors report a rare variation of the vasculature in the upper limbs of an 84-year-old male cadaver. A high bifurcation of the brachial artery occurred bilaterally at the proximal one-third of each arm. The radial arteries were larger than the ulnar arteries and gave origin to the common interosseous arteries. At the cubital fossa, the ulnar arteries traversed medial to the median nerves, continuing superficial to all forearm muscles except the palmaris longus tendon, characteristic of superficial brachioulnar arteries. The aforementioned variations have rarely been reported in previous literature and demonstrate important clinical significance in relation to accidental intra-arterial injections, errors in blood pressure readings, as well as orthopedic, plastic, and vascular surgeries of the upper limbs.

Superficial Brachio Ulnar Artery and other Vascular Variants in Left Upper Limb.

Background: Variations in origin, course and distribution of upper limb arteries are well documented and they have a great clinical significance. But the incidence of certain variations like presence of Superficial Brachioulnar Artery (SBUA) is less and its association with other vascular variations in hand are very few. Material: Human male cadaver of about 65 years age, received for student demonstration dissections provided the material for this study. Results & Observations: SBUA originated from brachial artery (BA) in the left upper limb of a human male cadaver. Other vascular variations noted were division of BA into radial artery (RA) and a common trunk (CT) for common interosseous and ulnar recurrent arteries (URA); and variant pattern in completion of Superficial Palmar arch (SPA). Conclusion: Arterial variations of upper limb have been reported to have clinical implications. A variant vessel like SBUA may be encountered during elevation of forearm flaps, or accidental injections of drugs into artery with mistaken identity for a vein, may land in severe complications. Added to these, knowledge of formation of palmar arterial arches and their branching pattern is important in reconstructive surgeries of hand.