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Unusual branching pattern of brachial artery - Embryological basis and clinicoanatomical insight

Hansdak R, Arora J, Sharma M, Mehta V, Suri RK, Das S

Clin Ter, 2015;166(2):65-7.
PMID: 25945432 DOI: 10.7417/CT.2015.1817

Variations in the arterial pattern of upper limb are of colossal importance to the surgeons as they are liable to iatrogenic injuries. During routine dissection for undergraduate medical students, an anomaly of brachial artery was discovered. The brachial artery terminated at higher level into ulnar and radial artery. The common interosseus artery took origin arising from radial artery. The ulnar artery did not give any branches in the forearm. Both radial and ulnar artery displayed a superficial course in the forearm. The anatomical knowledge of these variations may be of great help for the clinicians in planning and conducting flap harvesting during reconstructive surgeries and in arteriography.

Matched MeSH terms: Upper Extremity/blood supply
Trifurcation of brachial artery with variant course of radial artery: rare observation

Vollala VR, Nagabhooshana S, Bhat SM

Anat Sci Int, 2008 Dec;83(4):307-9.
PMID: 19159366 DOI: 10.1111/j.1447-073X.2008.00235.x

Variations in the arterial pattern of the upper limb have been observed frequently, either in the routine dissections or in clinical practice. The aim of the present study was to describe the anatomical, surgical and embryological importance of major arteries of upper limbs of human beings. The present article is the report of low division and trifurcation of brachial artery and abnormal course of radial artery (passing deep to the pronator teres muscle) found in a 45-year-old embalmed male cadaver. Knowledge of the arterial variations in the upper limb is of considerable importance during invasive and non-invasive investigative procedures or orthopedic, reconstructive, or surgical procedures.

Matched MeSH terms: Upper Extremity/blood supply
Classification of vascular function in upper limb using bilateral photoplethysmographic signals

Shariati NH, Zahedi E, Jajai HM

Physiol Meas, 2008 Mar;29(3):365-74.
PMID: 18367811 DOI: 10.1088/0967-3334/29/3/007

Bilateral PPG signals have been used for comparative study of two groups of healthy (free from any cardiovascular risk factors) and diabetic (as cardiovascular disease risk group) subjects in the age-matched range 40-50 years. The peripheral blood pulsations were recorded simultaneously from right and left index fingers for 90 s. Pulses have been modeled with the ARX440 model in the interval of 300 sample points with 100 sample points overlap between segments. Model parameters of three segments based on the highest fitness (higher than 80%) of modeled segments were retained for each subject. Subsequently, principal component analysis (PCA) was applied to the parameters of retained segments to eliminate the existing correlation among parameters and provide uncorrelated variables. The first principal component (contains 78.2% variance of data) was significantly greater in diabetic than in control groups (P < 0.0001, 0.74 +/- 2.01 versus -0.53 +/- 1.66). In addition the seventh principal component, which contains 0.02% of the data variance, was significantly lower in diabetic than in control groups (P < 0.05, -0.007 +/- 0.03 versus 0.005 +/- 0.03). Finally, linear discrimination analysis (LDA) was used to classify the subjects. The classification was done using the robust leaving-one-subject-out method. LDA could classify the subjects with 71.7% sensitivity and 70.2% specificity while the male subjects resulted in a highly acceptable result for the sensitivity (81%). The present study showed that PPG signals can be used for vascular function assessment and may find further application for detection of vascular changes before onset of clinical diseases.

Matched MeSH terms: Upper Extremity/blood supply*
Effect of isometric handgrip exercise on the size of cephalic veins in patients with stage 3 and 4 chronic kidney disease: A randomized controlled trial

Kumar A/L S Katheraveloo K, Suryani Safri L, Guo Hou L, Hafiz Maliki A, Md Idris MA, Harunarashid H

J Vasc Access, 2020 May;21(3):372-378.
PMID: 31581898 DOI: 10.1177/1129729819879314

BACKGROUND: Proper vascular access is essential for the long-term survival of chronic haemodialysis patients. The preferred vascular access in terms of long-term function is the native arteriovenous fistula. The success of native arteriovenous fistula depends mainly on a sufficient vein diameter. Thus, any intervention that could increase vein diameter before arteriovenous fistula creation could improve its patency. We conduct a study to investigate the effect of local physical training, namely handgrip exercise, on the distal forearm cephalic vein diameter in patients with chronic renal disease.
MATERIAL AND METHODS: A total of 34 chronic renal disease patients (stage 3 and 4) were recruited in a randomized controlled trial. Handgrip exercise was performed for 8 weeks in the intervention group. Handgrip-strength measurement and distal forearm cephalic vein diameter of a non-dominant hand with and without tourniquet was recorded (measurement is taken 1 cm proximal to the radial styloid).
RESULTS: After 8 weeks, the mean cephalic vein diameter in the intervention group increased from 1.77 and 1.97 mm to 2.15 and 2.43 mm, without and with a tourniquet, respectively (p < 0.05). There is also a significant change in the mean diameter of distal forearm cephalic vein (p < 0.05) in the intervention group when measured in both the absence (mean change 0.39 ± 0.06 mm vs 0.01 ± 0.02 mm) and the presence of tourniquet (mean change 0.47 ± 0.07 mm vs 0.01 ± 0.01 mm).
CONCLUSION: These findings suggest that non-invasive handgrip exercise can increase in the diameter of the distal forearm cephalic vein, thereby increasing the rate of successful arteriovenous fistula creation.

Matched MeSH terms: Upper Extremity/blood supply*
Bilateral central vein stenosis in a dialysis patient with a pacemaker

Yew KL, Anderson S, Farah R, Lim SH

Asian Cardiovasc Thorac Ann, 2014 Oct;22(8):979-80.
PMID: 24887840 DOI: 10.1177/0218492313491583

Central vein stenosis is not uncommon in hemodialysis-dependent patients as a result of mechanical damage to the vessel walls from prior cannulation. It can cause ipsilateral upper limb swelling and pain, resulting in suboptimal hemodialysis. It is unfortunate for bilateral central vein stenosis to develop concomitantly, and rare in the setting of an in-situ pacemaker. This case illustrates the successful ligation of a nondependent left arteriovenous fistula and stenting of the right subclavian vein with functioning ipsilateral arteriovenous fistula, to overcome the problem of symptomatic bilateral upper limb swelling.

Matched MeSH terms: Upper Extremity/blood supply*
Ultrasound-guided costoclavicular approach infraclavicular brachial plexus block for vascular access surgery

Beh ZY, Hasan MS

J Vasc Access, 2017 Sep 11;18(5):e57-e61.
PMID: 28478621 DOI: 10.5301/jva.5000720

INTRODUCTION: We report the use of a newly described regional technique, ultrasound-guided costoclavicular approach infraclavicular brachial plexus block for surgical anesthesia in two high-risk patients undergoing 2nd stage transposition of basilic vein fistula.
METHODS: Both patients had features of difficult airway, American Society of Anesthesiologists (ASA) physical status class III and central venous occlusive disease. The common approach, i.e., ultrasound-guided supraclavicular brachial plexus block was technically difficult with inherent risk of vascular puncture due to dilated venous collaterals at the supraclavicular area possibly compromising block quality. The risk of general anesthesia (GA) was significant as patients were morbidly obese with possible risk of obstructive sleep apnea postoperatively. As an alternative, we performed the ultrasound-guided costoclavicular approach infraclavicular brachial plexus block with 20 mL local anesthetic (LA) ropivacaine 0.5% delivered at the identified costoclavicular space using in-plane needling technique. Another 10 mL of LA was infiltrated along the subcutaneous fascia of the proximal medial aspect of arm.
RESULTS: Both surgeries of >2 hours' duration were successful, without the need of further local infiltration at surgical site or conversion to GA.
CONCLUSIONS: Ultrasound-guided costoclavicular approach can be an alternative way of providing effective analgesia and safe anesthesia for vascular access surgery of the upper limb.

Matched MeSH terms: Upper Extremity/blood supply*