Illustrated Encyclopedia of Human Anatomic Variation: Opus II: Cardiovascular System: Arteries: Upper Limb
Ronald A. Bergman, PhD
Adel K. Afifi, MD, MS
Ryosuke Miyauchi, MD
Peer Review Status: Internally Peer Reviewed
Major variations are present in about 25% of subjects studied and Poynter states that the variations are all explainable on an embryological basis.
Classification of Arm Arterial Variations (Müller, 1903, from Poynter).
In Group I.A., the brachial is doubled and consists of deep and superficial branches. It is the homologue of the superficial brachial described by Bayer (1893) for monkeys. Haller called it vasa aberrentia. In these cases, when the superficial branch persists it terminates in the proximal part of the radial, the ulnar, or the distal part of the brachial trunk. This variation was first reported by Ludwig in 1767.
Group I.B., The profunda drops out and the superficial brachial persists as the single trunk in the arm. This variation was reported by Chassaignac in 1834.
Group II.A., The brachial is doubled and the superficial brachial continues as the radial. This is known as high origin of the radial and is the most common of all arm variations. Müller has shown that developmentally the superficial brachial arises in three parts and therefore can account for the variation in the origin extending from the axillary to the lower third of the arm. Variations of this type were seen and reported by Fabricius (1754), Eschenbach (1755) and by Morenheim (1783).
Group II.B., The brachial is doubled and the superficial brachial continues as the ulnar.
Group II.1., The brachial is doubled and the superficial brachial continues as the median or the interosseus. In these cases the usual brachial continues as the radial and ulnar in the usual way. Less common than the preceeding two groups the variation represents the dropping out of the connection between the ulnar and the median. First noted by Barclay in 1812.
Group II.2., In this group the brachial is doubled and the superficial brachial continues as the radial and ulnar, the profunda as the interosseus. Probably first reported by Meckel in 1816.
Group II.3., The superficial antibrachial radial may be present either as a continuation of the superficial brachial or from profunda brachii. Found by Dubrueil in 1847.
Group II.4., Superficial antibrachial persists, ulnar may be doubled. This condition was described by Lucas in 1838.
In one study of 610 limbs, the usual textbook description of the axillary continuing as the brachial was observed in 80% of specimens.
A superficial brachial, a vessel that has a course anterior to that of the median nerve, was found in about 13%. The superficial branch continued as the radial twice as frequently as it continued as the ulnar artery. Less frequently it continued as both arteries.
A communication at the elbow between the superficial brachial and the usual brachial was seen occasionally.
One of the major variations is a high proximal division into
terminal branches (radial, 15%), ulnar (2%), common interosseous,
vas aberrans, and superficial median antebrachial artery). This
may occur at any point in the normal course of the vessel, but is
most common in the upper third of the arm and least common in the
middle third. The two vessels into which the brachial divides run
parallel to each other to the bend of the elbow, in the usual
position of the brachial. From this point, one branch follows the
normal course of the radial artery through the forearm and the
other takes the normal course of the ulnar artery, supplying as
usual the common interosseous artery. This arrangement is
considered a simple high division of the brachial artery. In the
following cases, the disposition of the two vessels is
different:
1) the two arteries communicate at the elbow by a cross branch, or
reunite and then divide again in the usual manner.
2) one vessel follows the course of the ulnar artery in the
forearm, and the other divides into the radial and common
interosseous.
3) one artery divides into the radial and ulnar as usual, and the
other takes the course of the common interosseous and divides into
the anterior and posterior interosseous arteries or, much more
rarely, takes the course of the posterior interosseous artery. The
anterior interosseous comes from the ulnar and finally,
4) the vessels follow a different course in the upper arm
different from that of the usual brachial.
The branch representing the radial may:
a) cross over or under the other branch,
b) perforate the deep fascia above the elbow and run beneath the
skin to its place in the forearm, or
c) pass behind the tendon of the biceps.
The branch representing the ulnar may:
1) run to the front of the medial epicondyle with the median
nerve, reaching its usual position by descending beneath the
fascia and the pronator teres muscle or, more rarely, beneath some
of the flexor muscles or merely beneath the skin, or
2) pass with the ulnar nerve behind the medial epicondyle and
beneath the muscles to its usual place in the forearm.
An enlarged vas aberrans (Haller) may be present. This long vessel arises from the brachial, usually near the origin of the profunda, and joins, most commonly, the radial artery or, more rarely, one of its branches or the ulnar. Normally it is quite small; it descends over the median nerve to the biceps muscle. At times this vessel takes the place of the brachial; the median nerve will then be found behind the artery.
The brachial may run with the median toward the medial epicondyle, where it may turn around, or beneath, a suprcondylar process if present (2.7% of individuals, Gruber) and then descend to its normal position beneath the pronator teres. It may also pass through the pronator teres muscle where it may be entrapped and compromised.
Latarjet suggests five possibilities for branching from a
premature division of the brachial artery:
1) Radial and ulnar-common interosseous trunk;
2) Ulnar and a radial-common interosseous trunk;
3) Common interosseous or persistent median artery and a
radioulnar trunk;
4) Radial, ulnar, and a common interosseous artery and
5) A vas aberrans and normal brachial artery.
The variations of this vessel is usually unilateral. Quain reported 61 cases, with 43 involving one side only and 18 involving both sides. In five of the 18 cases, the same variation was bilateral, and in 13 cases the variation differed on the two sides.
The brachial artery may give rise to a median cubital, a median articular cubital artery, or a branch to the mammary gland. It may be covered by various muscular slips derived from the adjacent muscles or those in its course.
The brachial artery may be compressed by the lacertus fibrosus of the biceps brachii muscle.
The frequency of brachial variations based on studies by various authors (3337 upper limbs) is about 20%.
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325A
Deep (Profunda)
Superficial inferior
Superficial superior
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Variations in Branches of Brachial Artery
The following variations have been recorded in the branches of
the brachial artery.
Profunda Brachii Artery
Superior Ulnar Collateral
Artery
Inferior Ulnar Collateral
Artery
Ulnar Artery
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