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6.
BRIEF RESUME OF THE INTENDED WORK
6.1 Need for the Study:
Knowledge of the normal anatomy and its variation has significant
practical importance to the vascular radiologist and to the surgeon. The axillary
artery is the preferred site for arterial coannulation in operations for ascending
aorta and aortic arch replacement in order to reduce perfusion related
morbidity in acute dissection and to prevent cerebral embolism.
The increasing use of invasive diagnostic and interventional procedures in
cardiovascular disease makes it important the type and frequency of vascular
variations are well documented and understood. Branches of the upper limb
arteries have been used for coronary bypass and flaps in reconstructive
surgery.
Most of the described variations can be identified with a careful preoperative examination. Failure to recognize these anomalies of the upper limb
vasculature may result in a compromised surgical outcome.
6.2 Review of Literature:
The axillary artery, a continuation of the subclavian artery begins at the
outer border of the first rib, and ends normally at the inferior border of teres
major, where it becomes the brachial artery. At first deep, it subsequently
becomes superficial, when it is covered only by the skin and fasciae/
pectoralis minor crosses it and so divides it into three parts which are proximal,
posterior and distal to the muscle. The branches of axillary artery are superior
thoracic from the first part, thoracoacromial and lateral thoracic artery from the
second part, anterior circumflex humeral, posterior circumflex humeral and
subscapular arteries from the third part.
Branches vary considerably an alar thoracic, often from the second part,
may supply fat and lymph nodes in the axilla. The lateral thoracic artery may
be absent when it is replaced by lateral perforating branches of the intercostals
arteries.1
Axillary artery may give rise to the radial artery or more rarely, the ulnar
artery. Still more rarely, it gives rise to the interosseous artery or a vas
aberrans. It may give rise to a common trunk, from which may arise the
subcapular, anterior and posterior circumflex humeral, profunda brachii and
ulnar collateral arteries. The axillary artery may be represented by two parallel
vessels that arise from the first portion of thesubclavian and continue distally
as the ulnar and radial arteries. The first part of the axillary may also provide
an accessory thoracoacromial artery.2
A unilateral variation in the origin and distribution of the arterial pattern of
the human upper extremity on the right side is reported on. Apart from its usual
branches, the third part of the right axillary artery gave origin to a common
branch, the profunda brachii artery and superior ulnar collateral artery.3
A vessel connecting the axillary or brachial artery to the radial one in a 65
years old male cadaver was observed during the dissection of the upper limb.
The anastomotic artery was originating from the medial side of the axillary
artery or the initial portion of brachial artery and coursed between the median
and musculocutaneous nerves in the arm, it passed to the forearm under the
bicipital aponeurosis and connected the main radial artery on the radial side of
the forearm. The anastomotic artery can be explained on the basis of its
embryological development.4
An anomalous origin of the suprascapular artery was observed in one of the
30 cadavers dissected. The suprascapular artery was seen to emerge from the
first part of axillary artery on the left side while on the right side it emerged
from the thyrocervical trunk.5
The subscapular arterial tree which is a branch of axillary artery offers a
predictable and versatile donor site that can meet the needs of many
microvascular reconstructions. The advantages of this arterial graft site are the
constant vascular anatomy, the adequate size, length and diameter of the
arteries in the tree, and the ease of its surgical dissection. By studying cadaver
dissection, it is possible to estimate the number of branches that may be found
at different arterial segment lengths from the origin of the subscapular artery.6
6.3 Objectives of the study:
To study the branching pattern of Axillary Artery.
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MATERIALS AND METHODS
7.1 Source of Data:
Embalmed human cadavers from the Department of Anatomy, J.J.M.
Medical College, Davangere.
Dead featus from Chigateri General Hospital, Bapuji Hospital and Women
and Child Health Hospital, Davangere.
7.2 Methods of Collection of Data (including sampling procedure if any):

Dissection method

Collection of data material studies by other workers in this field.

Sample size: 30
7.3 Does the study require any investigations or interventions to be conducted
on patients or other humans or animals? If so please describe briefly.
NO
7.4 Has ethical clearance been obtained from your institution in case of 7.3?
YES
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LIST OF REFERENCES
1)
Susan Standring Ed. “Gray’s Anatomy. The Anatomical basis of Clinical
Practice”. 39th Edn., London: Elsevier Churchill Livingstone 2005:
842-845pp.
2)
Bergman, Thompson, Afifi, Saadeh. “Compendium of Human Anatomic
Variation”. Urban & Schwarzenberg, Baltimore-Munich 1988, 7273pp.
3)
Ahmet Hilmi Yucel. “Unilateral Variation of the Arterial Pattern of the
Human Upper Extremity with a Muscle Variation of Hand”. Acta
Med Okayam. April 1999; 53 (2): 61-65.
4)
Ahmet Uzum, Leonard L Seelig Jr. The brachial artery to one of the
forearm, arteries via medica, Case report Folia Morphol. July
2000; 59 (3): 217-220.
5)
Mishra S, Ajmani ML. Anomalous Origin of Suprascapular Artery – A
Case Report. Journal of the Anatomical Society 2003; 52(2):
6)
Valnicek, Stanley M, Mosher, Matthew, Hopkins, Jason K, Rockwell W.
Braford. The subscapular Arterial Tree as a Source of
Microvascular Arteries Grafts. Division of Plastic Surgery,
University of Utha School of Medicine, June 30, 2003.