The origins of branches of the axillary artery in whites and in American negroes

Prevalence of Axillary Artery Variants and Their Clinical Significance: A Scoping Review

Axillary artery (AA) variants occurred quite commonly, presenting clinical implications. A literature search yielded 523 results from which 13 parameters were extracted. Some of the AA variants found were the fusion of two or more branches into common trunks, like the fusion of anterior and posterior circumflex humeral arteries. Moreover, several branches were found to emerge from different points than expected, like the lateral thoracic artery's origin from the subscapular artery instead of the second part of the AA. The importance of the knowledge of the AA variations in clinical practice is undeniable and very useful when planning interventional procedures, as in the case of AA aneurysm treatment or in cases of fracture of the surgical neck of the humerus. The heterogeneity of data limited the possibility of a quantitative summary of data. Therefore, a more systemic study of AA variants based on the origin, course, and branching pattern is suggested. The aim of the current review is to summarize current data literature regarding the AA typical anatomy and its variants, with a focus on their prevalence and possible clinical implications.

An unusual high bifurcation and variable branching of the axillary artery in a Greek male cadaver

Introduction

The axillary artery presents abnormalities in its origin and course and a variable branching.

Case description

A rare case of axillary artery bifurcation and branching was observed in a 60-years-old European male cadaver of Greek origin. The right axillary artery at the second part was bifurcated into a superficial and a deep brachial artery. The superficial brachial artery anteromedial to the median nerve and lateral to the ulnar nerve gave off the acromio-thoracic artery and two lateral thoracic arteries. The deep brachial artery behind the median nerve, after giving rise to the anterior circumflex humeral artery trifurcated into a branch that coursed distally, the posterior circumflex humeral artery and the subscapular artery. The latter subdivided into the circumflex scapular artery, a muscular branch for the subscapularis and the thoracodorsal artery. The continuation of the deep brachial artery divided laterally into a humeral nutrient artery and medially into a trunk which trifurcated into the profunda brachii artery, a deep muscular branch and a branch to the posterior compartment of the arm. The profunda brachii artery ended as radial and middle collateral arteries.

Discussion and evaluation

Deviations from the normal arterial pattern are of immense significance for anatomists, plastic, cardiovascular and orthopedic surgeons, vascular radiologists and interventional cardiologists.

Variations of the radial recurrent artery of clinical interest

PURPOSE

The anatomy of the radial recurrent artery (RRA) is important for different clinical procedures: interventional cardiology and microsurgery of the forearm; however, few studies have analysed its morphology: number, course, relations and distribution.

METHODS

The RRA was analysed in 332 upper limbs divided into two groups: (1) normal pattern of the arterial axis of the upper limb (266 cases), (2) associated with major arterial variations (66 cases).

RESULTS

A second or accessory RRA existed in 31.2 % in group 1, and 30.3 % in group 2. In both groups, the second RRA originated from the brachial (100 %) and always (100 %) coursed behind the bicipital tendon. The accessory RRA supplied the brachioradialis, brachialis and biceps brachii muscles. The RRA in group 1, originated mostly from the radial artery (75 %), followed by radioulnar division and ulno-interosseous trunk. In group 2, the RRA arise from the brachioradial artery (65 %), or from the radial artery (in cases of ulnar or brachial artery variation). The course of the RRA behind the biceps brachii tendon was observed in 9.4 % of group 1 and in 6.1 % of group 2. The RRA supplied the brachioradialis, extensor carpi radialis longus and brevis, and supinator muscles. The RRA and accessory RRA anastomosed forming a ring around the biceps brachii tendon in 0.75 % in group 1 and in 13.6 % in group 2, the latter group having an important clinical interest.

CONCLUSIONS

The variability of the RRA may provide an advantage for microsurgical procedures of the elbow and disadvantage during transradial catheterism.

A case of an extremely rare unilateral subscapular trunk and axillary artery variation in a male Caucasian: comparison to the prevalence within other populations

A male Caucasian cadaver was found to have a large common trunk that branched off of the first part of the axillary artery of the left arm. This trunk gave rise to all but two arterial branches of the axillary region. The large common trunk first gave off a thoracoacromial artery followed by the main branch, the subscapular artery. The subscapular was the origin of the posterior circumflex humeral and lateral thoracic arteries immediately proximal to bifurcating into its two terminal branches, the circumflex scapular and thoracodorsal arteries. Only the superior thoracic and anterior circumflex humeral arteries arose directly from the axillary artery. Also found was a high origin of the radial artery, noteworthy by its serpentine route. In comparison, in the right arm, no variants appeared in the axillary, subscapular, or brachial arteries. A comparison with branching patterns of axillary arteries from demographically similar and dissimilar populations revealed the extreme rarity of this set of anomalies.

Variations in branching pattern of the axillary artery: a study in 40 human cadavers

BACKGROUND: Variations in the branching pattern of the axillary artery are a rule rather than an exception. The knowledge of these variations is of anatomical, radiological, and surgical interest to explain unexpected clinical signs and symptoms. OBJECTIVE: The large percentage of variations in branching pattern of axillary artery is making it worthwhile to take any anomaly into consideration. The type and frequency of these vascular variations should be well understood and documented, as increasing performance of coronary artery bypass surgery and other cardiovascular surgical procedures. The objective of this study is to observe variations in axillary artery branches in human cadavers. METHODS: We dissected 80 limbs of 40 human adult embalmed cadavers of Asian origin and we have studied the branching patterns of the axillary artery. RESULTS: We found variations in branching pattern of axillary artery in 62.5% of the limbs. Anatomical variations included: origin of lateral thoracic artery from the subscapular artery; absent thoracoacromial trunk and all its branches arose directly from the second part of the axillary artery; division of thoracoacromial trunk into deltoacromial and clavipectoral trunks, which were divided into all branches of thoracoacromial trunk; origin of subscapular, anterior circumflex humeral, posterior circumflex humeral and profunda brachii arteries from a common trunk from the third part of the axillary artery; and origin of posterior circumflex humeral artery from brachial artery in addition to third part of the axillary artery. CONCLUSIONS: The study was carried out to show important variations in the branching pattern of axillary artery, in order to orient the surgeons performing angiography, coronary bypass, and flaps in reconstructive surgeries.

A case of a double variant of the arterial system in the upper extremity: Arteria brachialis accessoria et arteria comitans nervi mediani

A thorough knowledge of arteries of the upper extremity is necessary for catheterization, graft harvesting, shunt application, and Astrup?s examination. Coincidences of two different variants are rather rare. We present a case of the coincidental presence of arteria brachialis accessoria stemming from the arteria axillaris and reuniting with the arteria brachialis 1.5cm below the origin of the arteria collateralis ulnaris inferior; and arteria comitans nervi median originated in association with the arteria interossea communis from the arteria ulnaris, passing into the palm and towards the arteriae digitales palmares to the thumb, index and lateral side of the third finger. Such coincidence has never been reported before.

Bilateral double axillary artery: embryological basis and clinical implications

An unusual bilateral variation in the arterial pattern of the axilla was observed in an embalmed cadaver. Each axilla contained two axillary arteries of similar origins but different patterns of branching and fate. The first part of each axillary artery was a single vessel as is the norm. It gave off a supreme thoracic artery and then bifurcated into two medium-sized arteries hence referred to as regular and variant. The variant artery ran in an antero-medial course, partly covered by the one axillary vein. The regular artery gave off the thoracoacromial and two posterior branches from its second part, the anterior and posterior humeral circumflex arteries from its third part, and then continued as the brachial artery with all the usual branches except the profunda brachii on the right side. The variant gave off five arteries from the second part, a thoracoacromial artery, two separate long thoracic arteries each with a branch that ran along the intercostobrachial nerve to the arm, and two posterior branches. In the third part of the variant, the subscapular artery arose with its usual branches plus a common origin for two additional humeral circumflex arteries. The variant terminated as the profunda brachii artery to the right side while on the left side it terminated in muscular branches to the triceps. Hence, the arterial blood supply to the upper limb, and the axillary region in particular, was shared on both sides by two major arteries instead of one. These two arteries emanated from the first part of the axillary artery and may represent persisting branches of the capillary plexus of the developing limb buds. The findings have an embryological basis and clinical relevance considering the frequency of procedures in this region.

Rare variation of the axillary artery

The third part of the axillary artery unilaterally divides into two major arterial stems, named according to their localization as deep brachial artery and superficial brachial artery (brachial artery). The deep brachial artery gives off the posterior circumflex humeral artery, anterior circumflex humeral artery, subscapular artery, and profunda brachii artery. It continues its course in the arm lateral to the median nerve and terminates by giving a minute twig to the radial artery. The superficial brachial artery is larger in caliber than the deep brachial artery and gives no branches in the arm region. In the cubital fossa it gives the ulnar and the radial arteries. This case is a variant of the axillary artery that has been rarely (0.12-3.2%) documented in the literature. Accurate knowledge of the normal and variant arterial anatomy of the axillary artery is important for clinical procedures in this region. Clin. Anat. 13: 66-68, 2000.

A report of an anomalous bifurcation of the right axillary artery in man

The present report describes a variation of the axillary artery and its distribution to the axilla and thorax. In an adult white male cadaver an anomalous bifurcation was found to arise from the second part of the axillary artery. The artery bifurcated into superficial brachial and deep brachiothoracic branches. The lateral thoracic artery had a direct origin from the first part of the axillary artery. From the deep brachio-thoracic branch the following offshoots were evident: the independent anterior and posterior humeral circumflex, the subscapular, and a common trunk for the profunda branchii and superior ulnar collateral. The superficial brachial artery was the apparent con tinuation of the axillary artery in that it bifurcated into the radial and ulnar ar teries.