Download High origin of ulnar artery in South Indian male cadaver

Romanian Journal of Morphology and Embryology 2008, 49(4):573–575
CASE REPORT
High origin of ulnar artery in
South Indian male cadaver:
a case report
K. M. R. BHAT, B. K. POTU, S. GOWDA
Department of Anatomy, Kasturba Medical College,
Manipal University, Manipal, India
Abstract
Superficial ulnar artery, a rare variation may arise from axillary or brachial artery. Here we report a case of high origin of superficial ulnar
artery from the axillary artery. Superficial ulnar artery, after running under the bicipital aponeurosis in the cubital fossa, it terminated as
superficial palmar arch in the hand. We also discuss its clinical and embryological relevance.
Keywords: superficial ulnar artery, superficial palmar arch, bicipital aponeurosis, axillary artery.
Introduction
Ulnar artery usually arises from brachial artery as
one of its terminal branch in the cubital fossa.
Very rarely, the superficial ulnar artery (SUA),
which arises from the axillary, brachial or superficial
brachial arteries and courses over the forearm
flexor muscles and coexists with a brachial or
superficial brachial artery that branches into either the
radial and common interosseous arteries or, less
frequently, into the radial and an additional ulnar
arteries [1, 2].
Although, variations of the upper limb arterial
pattern are common, the presence of a SUA of high
origin, from the axillary artery, is considered as a rare
anatomical variation with clinical significance [2–5].
This report presents a case of unilateral SUA, arose
from the axillary artery along with its embryological
explanation and clinical significance.
Material and Methods
During routine dissection of 43 cadavers, in the left
upper limb of a 65-year-old south Indian male cadaver,
we found a superficial ulnar artery arising from the
axillary artery.
Results
The SUA originated from the left axillary artery at
the level of the junction of the two median nerve roots,
in close proximity with the inferior border of teres
major muscle (Figure 1).
The SUA after crossing over the lateral root of the
median nerve runs close and medial to the median nerve
in the upper and middle thirds of the arm close to the
biceps brachii muscle.
In the inferior third of the arm, the SUA was seen
running medial to median nerve on brachialis muscle.
In the cubital fossa, the SUA passed deep to the bicipital
aponeurosis and then ran in the ulnar side of the forearm
superficial to the forearm flexor muscles (Figure 2).
On reaching the hand, the SUA anastomosed with
the small twigs from the radial artery to form the
superficial palmar arch (Figure 3).
After the origin of the SUA, the axillary artery
continued as the brachial artery and divided into radial
and common interosseous arteries in the cubital fossa
(Figure 4). However, such variation was absent on the
other side.
Discussion
The superficial ulnar artery (SUA) is an anatomical
variation of the upper limb vasculature, which has a
prevalence of 0.7–9.4% in the population [6].
The SUA runs superficial to the flexor muscles of
the forearm, whereas the normal ulnar artery runs deep
and then divides into the anterior and posterior
interosseous arteries.
Lippert H and Pabst R (1985) has described that the
artery crosses over the lateral root of the median nerve
and supplies the biceps brachii muscle as a rare
variation [7].
The same variation was observed in our dissection.
The Course of SUA over the forearm flexor muscles
and underneath the bicipital aponeurosis was also
observed in this case, which is also not well reported in
the literature.
Many theories on the development of the arterial
system of the upper limb have been proposed over the
last two centuries, but none of the studies have yet
reached unanimous conclusion.
Recently, Rodríguez-Niedenführ M et al. (2001)
carried out a large embryological study and proposed
that the normal arterial system develops by selective
enlargement or regression of a capillary plexus and not
by budding from a main axial trunk [8].
574
K. M. R. Bhat et al.
Figure 1 – Showing the origin of the superficial ulnar
artery (SUA) from the axillary artery (AA).
LRM – lateral root of median nerve,
MRM – medial root of median nerve,
MN – median nerve
Figure 2 – Showing the course of superficial ulnar artery
in the lower third of arm and the cubital fossa. The
superficial ulnar artery (SUA) at the cubital fossa,
where it runs deep to bicipital aponeurosis (BiA).
MN – median nerve, BA – brachial artery,
RA – radial artery
Figure 3 – Showing the superficial ulnar artery (SUA)
passing through the lower third of forearm and
forming the superficial palmar arch (SPR) in
hand by joining with small braches (SRA)
from the radial artery (RA).
UN – ulnar nerve
Figure 4 – Branches of the brachial artery (BA) in the
cubital fossa. Brachial artery divides into common
interosseous artery (CIA) and radial artery (RA).
SUA – superficial ulnar artery,
MN – median nerve
Thus, SUA may be the result of persistence of one of
the capillary bud from the axilary artery. This proximal
to distal differentiation into the arterial tree gives a
simpler explanation for the large variation as the one
described in this case.
Apart from the anatomical rarity of a SUA
branching from the axillary artery, the persistence of
such a vessel, which usually runs along and crosses over
subcutaneous veins, is clinically important. A SUA may
complicate intravenous drug administration with
disastrous results, venipuncture in general and
percutaneous brachial catheterization. Owing to its
course, it is more prone to injury, resulting in bleeding.
Additionally, the artery may be mistaken for a vein, or
near the distal end of the forearm, it might be mistaken
for a persistent median artery [9, 10].
The knowledge of SUA is also important in
following clinical/surgical interventions: (1) As ulnar
artery may be used as microvascular recipient or donor
vessels, a knowledge of arterial variations is essential in
planning surgical and reconstructive procedures; it is
also important in ascending catheterization and surgical
intervention required in patients with thrombosed
forearm artery and poor collateral circulation; (2) While
treating the rupture of distal bicipital tendon, orthopedic
surgeon should be aware of this atypical blood vessel;
(3) The presence of an SUA need not always be
regarded as an adverse feature, as its presence may
allow plastic surgeons to use it in a reconstructive ulnar
flap [5].
High origin of ulnar artery in South Indian male cadaver: a case report
Conclusions
Knowledge of this variation is very important, not
only to anatomists, but also to angiologists, radiologists
and orthopaedic, plastic surgeons during their routine
clinical practice.
Acknowledgements
We sincerely thank Dr. Narga Nair, Professor and
Head of the Department of Anatomy, KMC, Manipal,
for her support and co-operation.
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Corresponding author
Kumar M. R. Bhat, Associate Professor, MD, PhD, Department of Anatomy, Kasturba Medical College,
Manipal University, Manipal, Karnataka–576104, India; Phone +91–820–2922327, Fax +91–820–2570061,
E-mail: [email protected]
Received: April 21st, 2008
Accepted: September 8th, 2008