LETTER TO THE EDITOR Year : 2022  |  Volume : 30  |  Issue : 4  |  Page : 133-134

High bifurcation of superficial brachial artery

Sudeshna Acharya1, Sourabh Shankar Chakraborty2, Ranjit Kumar Sahu3, Suresh Kotu4
1 Department of Trauma and Emergency, Goodwill Nursing Home, South Eastern Railway Central Hospital, Kolkata, West Bengal, India
2 Department Plastic Surgery, South Eastern Railway Central Hospital, Kolkata, West Bengal, India
3 Department of Burns and Plastic Surgery, AIIMS, Bhubaneswar, Odisha, India
4 Department of Burns and Plastic Surgery, HCG Hospitals, Bengaluru, Karnataka, India

Date of Submission11-Apr-2022Date of Acceptance30-May-2022Date of Web Publication09-Sep-2022

Correspondence Address:
Dr. Sourabh Shankar Chakraborty
Department of Plastic Surgery, South Eastern Railway Central Hospital, Kolkata - 700 043, West Bengal
India

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/tjps.tjps_20_22

How to cite this article:
Acharya S, Chakraborty SS, Sahu RK, Kotu S. High bifurcation of superficial brachial artery. Turk J Plast Surg 2022;30:133-4

Sir,

Anomalous brachial artery has been reported in 20% of cases.[1] Rodríguez-Niedenführ et al.[2] comprehensively categorized various brachial artery anomalies. They defined a superficial brachial artery when it courses in front of median nerve rather than behind. The prevalence of superficial brachial artery is 0.2%–25%.[3] Quain[4] was the first to report high bifurcation of brachial artery in 61 cadaveric specimens out of 429. Bifurcation of brachial artery is considered to be anomalous or high when it lies above the intercondylar line of humerus (it denotes the superior border of antecubital fossa).[5] The overall incidence in various cadaveric studies varies from 8% to 14.3%.[5],[6],[7] Kian et al.[7] observed that high bifurcation of brachial artery causes high failure rate and decreased patency of an arteriovenous fistula. Most studies reported high division of brachial artery in either cadaveric or radiological images only. To our knowledge, this is the first clinical intraoperative picture of high bifurcation of right brachial artery.

A 40-year-old male patient presented to us with machine crush injury in the right elbow. Examination revealed fracture of distal humerus and disruption of elbow joint accompanied by neurovascular and muscular injuries. On exploration, crushed anterior compartment muscles around elbow joint and loss of segment of ulnar artery and nerve, along with superficial brachial artery with bifurcation above the elbow (8.5 cm above the intercondylar line) were suggestive of anomalous brachial artery [Supplementary Video 1]. The median nerve and radial artery were intact. However, the radial artery was seen descending superficially in the forearm along the medial border of brachioradialis muscle. Elbow spanning externa fixation, cable graft repair of the ulnar nerve, and ulnar artery repair using vein graft and abdominal flap cover were done [Figure 1]. After a long rehabilitation, the patient recovered well.

Figure 1: High bifurcation of a superficial brachial artery. (A) Superficial brachial artery, (B) intact median nerve, (C) radial artery, (D) ulnar artery proximal segment, (E) ulnar nerve proximal segment, (F) sural nerve cable graft, (G) ulnar nerve distal segment, (H) ulnar artery distal segment

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Brachial artery is used in many diagnostic and therapeutic interventions in various diseases and traumatic conditions. Awareness of a high bifurcation of brachial artery and, that it lies superficial to the median nerve in the arm, is therefore a requisite for every plastic surgeon, intervention radiologist, trauma surgeon, cardiologist, and vascular surgeons.

Ethical standards

For this article no studies with human participants or animals were performed by any of the authors. All studies performed were in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki. Informed consent was taken from the patient regarding dissemination of the clinical picture for research and publication purposes. This paper has not been sent anywhere else for publication.

Consent for publication

Informed consent was obtained from the participant included in the study.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 

  References 
1.Bergman RA, Afifi AK, Miyauchi R. Illustrated Encyclopedia of Human Anatomic Variation; 2006. Available from: http://www.anatomyatlases.org/AnatomicVariants/AnatomyHP.shtml. [Last accessed on 2022 Mar 11].  
    2.Rodríguez-Niedenführ M, Vázquez T, Nearn L, Ferreira B, Parkin I, Sañudo JR. Variations of the arterial pattern in the upper limb revisited: A morphological and statistical study, with a review of the literature. J Anat 2001;199:547-66.  
    3.Singla RK, Sharma R, Sharma R, Sharma T. Superficial brachial artery with its high division. JNMA J Nepal Med Assoc 2012;52:138-41.  
    4.Quain R. Anatomy of the arteries of the human body. London: Taylor & Walton; 1844.  
    5.Mccormack LJ, Cauldwell EW, Anson BJ. Brachial and antebrachial arterial patterns; A study of 750 extremities. Surg Gynecol Obstet 1953;96:43-54.  
    6.Cherukupalli C, Dwivedi A, Dayal R. High bifurcation of brachial artery with acute arterial insufficiency: A case report. Vasc Endovascular Surg 2007;41:572-4.  
    7.Kian K, Shapiro JA, Salman L, Khan RA, Merrill D, Garcia L, et al. High brachial artery bifurcation: Clinical considerations and practical implications for an arteriovenous access. Semin Dial 2012;25:244-7.  
    
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