49 - Identification of a Rare Superficial Brachioulnoradial Artery and Deep Brachiointerosseous Artery in the Upper Limb of a Cadaveric Donor: A Case Report

Poster Board Number: 49
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Co-authors:

Emily MacPherson, MSc - Surgical Pathologist Assistant, Yellowstone Pathology Institute; Andre Williams - University of Toronto; Logan Bale, MSc - Laboratory and Educational Coordinator, Anatomy, Biomedical and Molecular Sciences, Queen's University; Leslie MacKenzie, PhD - Associate Professor of Anatomy, Biomedical and Molecular Sciences, Queen's University

Abstract Body : INTRODUCTION & OBJECTIVE: Upper limb vasculature variations occur in approximately 11-24% of the population. The discovery of a rare unilateral upper limb arterial variation is discussed in the current study. A high brachial artery bifurcation into a superficial brachioulnoradial artery (SBURA) and deep brachiointerosseous artery (DBIA) was observed in a cadaveric donor. The exact presentation of this variation has yet to be described in current literature. This study characterizes, through comprehensive dissection, this variation for clinical and educational applications. Knowledge of the variation remains relevant in medical practice to inform approaches to upper limb procedures to avoid iatrogenic injury.

METHODS: The variation was discovered incidentally in the left upper limb of a formalin-fixed 76-year-old Caucasian male cadaver during an educational dissection. Comparisons between typical arterial branching patterns relative to local landmarks and those in the current case helped to characterize the variation. Gross dissection of upper limb arteries consisted of removing successive layers of skin, subcutaneous fat, and fascia to consolidate and characterize the totality of the variation for educational presentation. A microdissection of the DBIA helped to visualize the course of the anterior and posterior interosseous arteries.

RESULTS: The left brachial artery bifurcated unusually high, immediately distal to the origin of the profunda brachii artery, inferior to the lower margin of the teres major muscle. It formed two equivalent branches: a SBURA and DBIA. The SBURA coursed superficial to the DBIA with the median nerve coursing between. The SBURA bifurcated in the cubital fossa, giving rise to two atypical branches: a superficial radial artery (SRA) and superficial ulnar artery (SUA). The SRA and SUA coursed superficial to the forearm musculature before anastomosing to form the superficial palmar arch of the hand. The contributions of the SRA and SUA to the superficial palmar arch, typically formed by the ulnar artery and superficial palmar branch of the radial artery, are rare. The DBIA crossed the elbow medial to the biceps brachii tendon where it bifurcated to form typical anterior and posterior interosseous arteries.

CONCLUSION: This study characterized the anatomy of a unilateral upper limb arterial variation with respect to local landmarks and through comparison to typical anatomy. Case reports such as this help to form a catalog of anatomical variations necessary for high-quality clinical practice. Knowledge of upper limb arterial variations can help mitigate clinical malpractice including improper blood pressure readings, unintentional intraarterial injections, and iatrogenic injury.