Bilateral trifurcation of brachial artery

Int J Biol Med Res. 2011; 2(4): 1193 -1194
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Case report
Bilateral Trifurcation of Brachial Artery - A Case Report
CK Reddya*, NA Syeda, M J Phukona, R Duttaa
a*
Associate professor, Department of Anatomy
Department of anatomy, prathima institute of medical sciences, nagunur , karimnagar, A.P, INDIA.
a
ARTICLE INFO
ABSTRACT
Keywords:
Brachial artery
Bilateral trifurcation
Radial recurrent artery
The variations in the arterial pattern specially in the extremities are common. The trifurcation
of brachial artery into radial, ulnar and either common interosseous or median artery are
found commonly, but radial recurrent artery as a third branch is very rarely reported. Here we
are reporting a rare case of bilateral trifurcation of brachial artery into radial, ulnar and radial
recurrent artery in an adult female cadaver found during routing dissection in the department
of anatomy.
c Copyright 2010 BioMedSciDirect Publications IJBMR -ISSN: 0976:6685. All rights reserved.
1. Introduction
According to a study conducted on 50 upper limbs by patnaik et
al [1] the brachial artery showed variations in 26% and only in one
instance i.e. 2% the brachial artery trifurcated into radial, ulnar
and radial recurrent artery. There is not much literature available
on the trifurcation of brachial in which the third branch is radial
recurrent artery, though common interosseous and median artery
as the third branch are reported earlier [2].
A very rare anomaly of bilateral trifurcation of brachial artery in
an adult female cadaver was found during routine dissection in the
department of anatomy. The origin, course and other branches of
the brachial artery was traced and found to be as per the standard
description. The brachial artery terminated into three branches
near the neck of the radius in both the upper limbs of same cadaver.
The common interosseous artery arose from the ulnar artery, on
further tracing the ulnar artery was ended by anastomosing with
the radial artery by running medially and deep to flexor muscles of
forearms. The radial artery was also traced and found to be of
standard description.
The third main branch i.e radial recurrent artery after its origin
from the brachial artery turned laterally upwards medial to radial
nerve(figure 1&2). The artery gave few muscular branches, an
* Corresponding Author : Dr. C. Kishan Reddy
Associate professor, Department of Anatomy
Prathima institute of medical sciences, Karimnagar, A.P, INDIA.
Mobile: 09885810645
E-mail: reddykishan82@yahoo.in
c
Copyright 2010 BioMedSciDirect Publications. All rights reserved.
articular branch to the elbow joint and finally ended by
anastomosing with the radial collateral and descending branch of
profunda brachii artery.
2.Discussion
According to patnaik et al (2002)[1], there were 26% variations
in the branching pattern of brachial artery in a study conducted on
50 upper limbs; apart from other variations they could found only
one case of unilateral trifurcation of brachial artery into radial,
ulnar and radial recurrent artery.
Patnaik et al [3] reported a case of unilateral trifurcation of
brachial artery in a male cadaver, the third branch being radial
recurrent artery. The anomaly we found is bilateral in a female
cadaver.williams et al [4] have made a reference under variations
of brachial artery, that brachial artery frequently divides more
proximally into radial, ulnar and common interosseous but they
are silent about detail description. The third branch mentioned by
the above workers is common interosseous and not the radial
recurrent artery as found in our case.
Huber [2] stated that supernumerary branches accessory to
usual branches may arise from brachial artery giving origin to
radial recurrent artery, common interosseous artery or to the
median artery. From the above it can be inferred that the third
branch in trifurcation of brachial artery is common interosseous
and the radial recurrent artery may arise as one of the branches.
CK Reddy / Int J Biol Med Res. 2011; 2(4): 1193 -1194
1194
3.Ontogeny
Figure 1 (right upper limb)
Figure2(left upper limb)
According to Singer (1933)[5] figure 3 the ulnar artery (c)
arises from brachial artery (b) and unites distally with median
artery to form superficial carpal arch. The superficial brachial
artery (f) develops in axillary region and traverses medial
surface of arm and runs diagonally from ulnar to the radial side of
the forearm. Finally at the elbow an anastomotic branch (e)
between brachial artery (b) and superficial brachial artery (f)
becomes enlarged sufficiently to form with the distal portion of
the later (g), the radial artery (i.e. developing from e and g) as
major artery of the forearm. While the proximal portion of
superficial brachial artery (f) remains small as radial recurrent
artery which now looks as arising from radial artery (e &g). The
proximal part of ulnar artery in adult develops from part of
brachial artery between the anastomotic channel (e) between
superficial brachial artery and brachial artery and the ulnar
artery proper (c) in its distal part.
Figure 3
Keys:
1)Median nerve 2) Brachial artery 3) Radial recurrent artery
4) Radial artery 5)Ulnar artery 6) Radial nerve
7) Brachialis muscle
4.References
[1] Patnaik et al. Branching pattern of brachial artery-A morphological study.
Journal of anatomical society of India.2002; 51 (2):176-186 2002.
[2] Huber G C. Piersol's Human Anatomy. In : The vascular system. 9th
Edn.Vol.1, J.B. Lippincott co, Philadelphia.:pp 767-791. 1930.
[3] Patnaik et al .trifurcation of brachial artery – a case report.journal of the
anatomical society of India.2001; 50 (2): 163-165.
[4] Williams PL et al .”Gray's Anatomy”. In : cardiovascular system .Gabella G
Edr.38th Edn. Churchill Livingstone.New York.: pp. 1537-44 .1999.
[5] Singer E . Embryological patterns persisting in arteries of the arm.
Anatomical record .1933; 55: pp. 406-441.
Inference:
Probably trifurcation of brachial artery may be due to
1. Non obliteration of axis(median) artery
2. Common interosseous artery may be arising
from brachial artery at its termination into
radial and ulnar arteries
3. Perhaps in this case the cause may be high
origin of radial recurrent artery at the termination of
brachial artery
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All rights reserved.