Int J Anat Res 2015, 3(1):906-09. ISSN 2321-4287 906

Case Report

ANOMALOUS ORIGIN OF ANTERIOR INTEROSSEOUS ARTERYBanani Kundu *1, Abhijit Biswas 2, Phalguni Srimani 3, Alpana De 4.

ABSTRACT

Address for Correspondence: Dr. Banani Kundu, R G Kar Medical College, 1, Khudiram BoseSarani, Kolkata 700 004, India. Mobile: +91 9433366549 E-Mail: dr.bmitra@yahoo.com

*1 Assistant Professor of Anatomy, R G Kar Medical College, Kolkata, India.2,3 Post Graduate Trainee of Anatomy, R G Kar Medical College, Kolkata, India.4 Professor and Head of the Department of Anatomy, R G Kar Medical College, Kolkata, India.

Background: The Brachial Artery ,usually a continuation of the axillary artery begins at the distal borderof teres major and ends about a centimetre distal to the elbow joint by dividing into the radial and ulnarartery.Objectives: A. To document the origin of anterior interosseous artery from brachial artery. B. To establishembryological and clinico-anatomical correlation of such variations.Methods: These findings were observed after meticulous dissection of the upper limbs of both sides ofa 43 year old adult male cadaver in the department of anatomy ,R .G .Kar Medical College ,Kolkata.Results: The brachial artery present in the right limb gave a branch in the upper 1/3 of the arm fromits lateral aspect. This branch of brachial artery went downwards and became deep to pronator teres andcontinued as the anterior interosseous artery. The brachial artery itself descended and remainedsuperficial to pronator teres. Just below the elbow joint it underwent bifurcation into radial and ulnarartery.The subsequent course of those two arteries was normal. And there was absence of commoninterosseous artery. So the anterior interosseous artery instead of arising from the common interosseousartery which was the branch of the ulnar artery took origin from brachial artery.Conclusion: This variation was explained in the light of embryological development and such variationswere useful for physicians, surgeons, nephrologists ,radiologists and interventionist in various surgicalprocedures and also for diagnostic and therapeutic approaches.KEY WORDS: Brachial artery, Radial artery, Ulnar artery, Anterior Interosseous artery.

BACKGROUND

International Journal of Anatomy and Research,Int J Anat Res 2015, Vol 3(1):906-09. ISSN 2321- 4287

DOI: http://dx.doi.org/10.16965/ijar.2015.108

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Received: 28 Jan 2015 Accepted: 16 Feb 2015Peer Review: 28 Jan 2015 Published (O):31 Mar 2015Revised: None Published (P):31 Mar 2015

International Journal of Anatomy and ResearchISSN 2321-4287

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DOI: 10.16965/ijar.2015.108

Brachial artery is a continuation of the axillaryartery. It begins at the distal border of theteres major muscle and ends by dividinginto two branches, lateral one is the radialartery and medial one is the ulnar artery [1].The division takes place at the level of neckof radius (one centimetre distal of the elbowjoint).

Sometimes the artery divides proximally intotwo trunks, which may reunite. Previous studydone by Compendium of Human AnatomicVariation [2] highlighted that major variationswere present in about 25% of the subjectsstudied for the brachial artery. The arteryundergoes high up division than normal andthis short brachial artery may bifurcatenormally or sometimes it may trifurcate into

Int J Anat Res 2015, 3(1):906-09. ISSN 2321-4287 907

Banani Kundu, Abhijit Biswas, Phalguni Srimani, Alpana De. ANOMALOUS ORIGIN OF ANTERIOR INTEROSSEOUS ARTERY.

radial (15%), ulnar (2%) and commoninterosseous artery. This high division mayoccur at any point in the normal course ofthe vessel, but it is more common in themiddle third. The two vessels run parallel toeach other to the bend of the elbow, in theusual position of the brachial artery. Fromthis point, one branch follows the normalcourse of the radial artery through theforearm and the other one takes the normalcourse of the ulnar artery. This arrangementis considered a simple high division of thebrachial artery.Occasionally radial artery arises moreproximally leaving a common trunk for ulnarand common interosseous artery [1]. Proximaldivision of brachial artery is due to failureof disappearance of the proximal origin ofradial artery and the radial artery does notestablish new connection with the main trunknear the origin of the ulnar artery [3].High up division of the brachial artery canalso be explained by Arey where hecommented that, there may be persistenceof vessels which normally obliterate anddisappearance or failure of development ofvessels which normally persist [4]. This reversalof the normal process of vasculardevelopment is largely due to altered localhemodynamic environment [5].Finally, knowledge of variation of thebranching pattern of brachial artery isnoteworthy especially in the field oforthopedic, radiology, vascular and plasticsurgeries [6].In the present case report, we focused onthe anatomical and embryological basis ofthis arterial variation and discussed itsclinical significance along with relevant reviewof literature.

CASE REPORT

These findings were observed during routinedissection of the upper limbs of both sidesof a 43 year old adult male cadaver in thedepartment of anatomy, R .G. Kar MedicalCollege, Kolkata. The brachial artery presentin right limb gave one branch in upper 1/3rdof arm. Then the main artery descended and

RESULTS AND DISCUSSION

remained superficial to pronator teres. Justbelow the elbow joint it underwent bifurca-tion into radial artery laterally and ulnar ar-tery medially. Subsequent course of those twoarteries was normal. The other branch of bra-chial artery went downwards and becamedeep to pronator teres and continued as theanterior interosseous artery. So the anteriorinterosseous artery instead of arising fromthe ulnar artery it took origin from brachialartery and there was absence of commoninterosseous artery.

Anomalies of the upper limb arterial tree arevery much common. This is mainly becauseof their multiple and plexiform sources, thetemporal succession of emergence of principalarteries, anastomoses and periarticularnetworks and functional dominance followedby regression of some paths [7]. Severalvariations with regard to the origin andtermination of the brachial artery have beenreported by many earlier research workers.High origin of radial and ulnar artery formsthe highest percentage of variations ofbrachial artery. High origin of radial arteryoccurrence is 3 to 15%, as reported bydifferent authors. The parent trunk beingaxillary artery in 12.5%, proximal 1/3 ofbrachial artery in 62.5% and middle 1/3 ofbrachial artery in 25% [8].Occasionally the brachial artery dividesproximally into two trunks, which may reunite.Frequently it undergoes high up division morethan usual, and this short brachial arterymay bifurcate as usual or it may trifurcateinto radial, ulnar and common interosseousarteries. More often the radial branches ariseproximally, leaving a common trunk for theulnar and common interosseous; sometimesthe ulnar artery arise proximally, the radialand common interosseous arteries formingthe other division; the common interosseousartery may also arise proximally[7].Guha et al. reported a case where in themiddle of the arm brachial artery undergoesdivisions into radial and ulnar arteries. Thisvariation was associated with variant median

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Banani Kundu, Abhijit Biswas, Phalguni Srimani, Alpana De. ANOMALOUS ORIGIN OF ANTERIOR INTEROSSEOUS ARTERY.

Fig. 1: Showing origin of anterior interosseous arteryfrom brachial artery.

Fig. 2: Origin of the Radial ,Ulnar & AnteriorInterosseous arteries From Brachial artery.

nerve and absent musculocutaneous nerve[9].Embryological Explanation: Every variations inthe peripheral vascular anatomy can berelated to genesis, regression or persistenceof one or other segment of the embryologicaxial artery [10].Arey and Jurjus reported six explanations forthe variations in the blood vessels of upperlimb [4,11]. These are the choice of unusualpaths in the primitive vascular plexus, thepersistence of vessels which are usuallyobliterated, the disappearance of vesselswhich are normally retained, an incompletedevelopment, the fusion and absorption ofparts which are normally distinct and acombination of factors leading to an atypicalpattern normally encountered.The axis artery of the upper limb bud isderived from the lateral branch of the seventhintersegmental artery. Proximal part of themain trunk forms the axillary and brachialarteries and its distal part persists as theanterior interosseous artery, close to the bendof the elbow the axis artery gives rise toradial and ulnar artery which are the latestarteries to appear in the forearm from theaxis artery. Probably in this case the axis arteryundergoes bifurcation. It is important tomention that the normal vasculardevelopment including the patterning of the

blood vessels is influenced greatly by thelocal hemodynamic factors. Altered hemo-dynamic environment may give rise to variantpatterning of blood vessels [6]. In this casealso due to difference of flow gradient thelateral division of the axis artery graduallybecame narrower and it formed the anteriorinterosseous artery. The medial branchbecame dominant and it was continued asthe brachial artery and gave two morebranches the radial and ulnar artery.

CONCLUSION

Thus any factors affecting during developmentof the limb vessels will lead to anomalies inthe level of division of major arteries.Knowledge regarding such variations are verymuch important for the radiologists,cardiologists, orthopaedic and vascularsurgeon. Diagnostically this type of variationmay disturb the evaluation of angiographicimages. Surgeon should be aware of suchvariation before doing any upper limb surgeryto prevent injury, thrombosis specially inpatients requiring dialysis or arteriography.We hope that our study has provided valuabledata to the clinicians and anatomists byenhancing their knowledge regarding thevariation of the blood vessels of the upperlimb as it helps to avoid serious complicationsin surgery and angiographic procedures.

Int J Anat Res 2015, 3(1):906-09. ISSN 2321-4287 909

Banani Kundu, Abhijit Biswas, Phalguni Srimani, Alpana De. ANOMALOUS ORIGIN OF ANTERIOR INTEROSSEOUS ARTERY.

ACKNOWLEDGEMENTThe authors express their heartfelt gratitudeto all the members of the Department ofAnatomy, R G Kar Medical College, Kolkatafor their kind support, cooperation andgenerosity in the conduct of this study.

Conflicts of Interests: None

REFERENCES

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[3]. Shewale SN, Sukre SB,Diwan CV. Bifircation ofbrachial artery at its commencement:A casereport.Biomedical research. 2012;23(3):453-456.

[4]. Arey LB. Developmental Anatomy. 6th Ed.Philadelphia, W.B. Saunders. 1957;375–377.

[5]. Rodriguez-Baeza A, Nebot J, Ferreira B, Reina F,Perez J, Sanudo JR, Roig M. An anatomical studyand ontogenetic explanation of 23 cases withvariations in the main pattern of the humanbrachioantebrachial arteries. J Anat. 1995;187:473–479.

[6]. Gonzalez-Compta X. Origin of the radial artery fromthe axillary artery and associated hand vascularanomalies. Journal of Hand Surg. 1991;16A:293–296.

[7]. Williams PL, Bannister LH, Berry MM, Collins P,Dyson M, Dussek JE, Ferguson MW, eds. Gray’sAnatomy. 38th Ed., London, Churchill Livingstone.1999;319,1539.

[8]. Teli C, K N Nilesh, N Paarthipan. A case report ofhigh division and variation in brachial arterybranching pattern. IOSR Journal of Dental andMedical Sciences. Jan-Feb2013;3(6):68-70.

[9]. Guha R, Palit S. A rare variation of anomalousmedian nerve with absent musculocutaneous nerveand high up division of brachial artery. J Interacad.2005;9:398–403.

[10].Anuradha L,Prabhu LV,Kumar A.Report on ananomalous pattern in the upper limb with itsanatomical and clinical implication.J Anat SocIndia,2001;50(1):69-98.

[11]. Jurjus A,Sfeir R,Bezirdjian R.Unusual variationof the arterial pattern of the human upper limb.AnatRec. 1986;215:82-83.

How to cite this article:Banani Kundu, Abhijit Biswas, Phalguni Srimani, Alpana De.ANOMALOUS ORIGIN OF ANTERIOR INTEROSSEOUS ARTERY.Int J Anat Res 2015;3(1):906-909. DOI: 10.16965/ijar.2015.108