Jornal Vascular Brasileiro ISSN: 1677-5449 [email protected] Sociedade Brasileira de Angiologia e de Cirurgia Vascular Brasil Astik, Rajesh; Dave, Urvi Variations in branching pattern of the axillary artery: a study in 40 human cadavers Jornal Vascular Brasileiro, vol. 11, núm. 1, marzo, 2012, pp. 12-17 Sociedade Brasileira de Angiologia e de Cirurgia Vascular São Paulo, Brasil Available in: http://www.redalyc.org/articulo.oa?id=245023701001 How to cite Complete issue Scientific Information System More information about this article Network of Scientific Journals from Latin America, the Caribbean, Spain and Portugal Journal's homepage in redalyc.org Non-profit academic project, developed under the open access initiative ORIGINAL ARTICLE Variations in branching pattern of the axillary artery: a study in 40 human cadavers Variações na ramificação do padrão da artéria axilar: um estudo em 40 cadáveres humanos Rajesh Astik1, Urvi Dave2 Abstract Background: Variations in the branching pattern of the axillary artery are a rule rather than an exception. The knowledge of these variations is of anatomical, radiological, and surgical interest to explain unexpected clinical signs and symptoms. Objective: The large percentage of variations in branching pattern of axillary artery is making it worthwhile to take any anomaly into consideration. The type and frequency of these vascular variations should be well understood and documented, as increasing performance of coronary artery bypass surgery and other cardiovascular surgical procedures. The objective of this study is to observe variations in axillary artery branches in human cadavers. Methods: We dissected 80 limbs of 40 human adult embalmed cadavers of Asian origin and we have studied the branching patterns of the axillary artery. Results: We found variations in branching pattern of axillary artery in 62.5% of the limbs. Anatomical variations included: origin of lateral thoracic artery from the subscapular artery; absent thoracoacromial trunk and all its branches arose directly from the second part of the axillary artery; division of thoracoacromial trunk into deltoacromial and clavipectoral trunks, which were divided into all branches of thoracoacromial trunk; origin of subscapular, anterior circumflex humeral, posterior circumflex humeral and profunda brachii arteries from a common trunk from the third part of the axillary artery; and origin of posterior circumflex humeral artery from brachial artery in addition to third part of the axillary artery. Conclusions: The study was carried out to show important variations in the branching pattern of axillary artery, in order to orient the surgeons performing angiography, coronary bypass, and flaps in reconstructive surgeries. Keywords: angiography; axillary artery; cardiovascular surgical procedures; coronary artery bypass; median nerve. Resumo Contexto: As variações no teste padrão de ramificação da artéria axilar são preferencialmente uma regra do que uma exceção. O conhecimento destas variações é de interesse anatômico, radiológico e cirúrgico para explicar os sinais e sintomas clínicos inesperados. Objetivo: O grande percentual de variações no padrão de ramificação da artéria axilar deve ser levado em consideração. O uso crescente de procedimentos invasores e intervencionistas em procedimentos cirúrgicos cardiovasculares e em cirurgias reconstrutivas da região axilar faz com que seja mais importante que o tipo e a frequência destas variações vasculares sejam entendidos e documentados. Métodos: Oitenta membros de 40 cadáveres adultos embalsamados de origem asiática foram dissecados, e os testes padrões de ramificação da artéria axilar foram estudados. Resultados: Foram encontradas variações no padrão de ramificação da artéria axilar em 62,5% dos membros. Variações anatômicas incluíram: origem da artéria torácica lateral da artéria subescapular; tronco toracoacromial ausente e todos os ramos surgiram diretamente a partir da segunda parte da artéria axilar; divisão do tronco toracoacromial em troncos deltoacromial e clavipeitoral, que foram divididos em todos os ramos do tronco toracoacromial; origem do subescapular umeral circunflexo anterior, umeral circunflexo posterior e artérias braquiais profundas a partir de um tronco comum da terceira parte da artéria axilar; e origem da artéria umeral circunflexa posterior da artéria braquial, além de terceira parte da artéria axilar. Conclusões: O estudo foi realizado para mostrar as importantes variações no teste padrão de ramificação da artéria axilar para orientar os cirurgiões que realizam angiografias, pontes de safena e retalhos em cirurgias reconstrutivas. Palavras-chave: angiografia; artéria axilar; procedimentos cirúrgicos cardiovasculares; revascularização; nervo mediano. Study carried out at GSL Medical College – Rajahmundry, District East Godavari, India. 1 Associate professor at the Department of Anatomy of GSL Medical College – Rajahmundry, District East Godavari, India. 2 Tutor at the Department of Anatomy of GSL Medical College – Rajahmundry, District East Godavari, India. Financial support: none. Conflict of interests: nothing to declare. Submitted on: 07.31.10. Accepted on: 09.13.11. J Vasc Bras. 2012;11(1):12-17. A study in 40 human cadavers - Astik R et al. J Vasc Bras 2012, Vol. 11, Nº 1 13 Introduction their courses and variations if present, and photographs were taken for recording. The axillary artery is a continuation of the subclavian Statistical comparisons between percentages were one from outer border of the first rib to lower border of teres performed by the χ2 test; p<0.05 was regarded as statisti- major muscle that continues further distally as brachial ar- cally significant. tery. It is classically divided into three parts by the pectora- For the dissection of the cadavers, investigations and lis minor muscle. It is conventionally described as giving of materials were used in the study, the required permissions six branches. The branches vary considerably, in up to 30% were taken from appropriate firms within the institute, and of the cases, the subscapular artery can arise from a com- all the methods were followed in-line with international mon trunk with the posterior circumflex humeral artery. ethics and values. Occasionally, the subscapular, anterior circumflex humeral, posterior circumflex humeral, and profunda brachii arteries Results arise in common. The posterior circumflex humeral artery may arise from the profunda brachii artery, and pass back We found variant branching pattern of the axillary ar- below the teres major to enter the quadrangular space1. tery in 43 out of 68 limbs (63% limbs) in males and 7 limbs The number of branches that arose from the axillary out of 12 limbs (58% limbs) in females. The variant branch- artery showed considerable variations: two or more of usual ing pattern was found in 26 male cadavers (76.4%), unilat- branches may arise by a common trunk or named artery erally in 9 cases (five right, four left) and bilaterally in 17. It viz. deltoid, acromial, clavicular or pectoral branch may was found in four female cadavers (66.7%), with one unilat- arise directly from axillary artery2. eral case on the right side and three bilateral. Consequently, Accurate knowledge of the normal and variant arte- the total incidence of variant branching pattern of the axil- rial anatomy of the axillary artery is important for clinical lary artery was 30 out of 40 cadavers (75%) or 50 out of 80 procedures in this region3. Branches of axillary artery are upper limbs (62.5%). used for coronary bypass and flaps in reconstructive surger- Our results showed six different arterial variations of the ies. Sound knowledge of variation in branching pattern is axillary artery. Each of them was separately analyzed in important for surgeons’ attempting to reduce old disloca- the following paragraphs. tions, especially when the artery is adherent to the articular We found the origin of lateral thoracic artery from sub- capsule1. scapular artery in eight male cadavers (23.5%), unilaterally in two cases on the right side and bilaterally in six (Figure 1). Methods Lateral thoracic artery arose from subscapular artery in one female cadaver (16.7%) bilaterally. Thus, the total incidence This study was approved by the Ethics Committee of origin of the lateral thoracic artery from subscapular ar- from the GSL Medical College, institution in which this tery was 9 out of 40 cadavers (22.5%) or 16 out of 80 up- study was carried out, under the protocol of GSLMC/ per limbs (20%). The χ2 test did not show any statistically Ethics/05/20122009. The axillary arteries belonging to 80 upper limbs of 40 cadavers of Asian origin (34 males and 6 females) were selected to dissect for routine educational purposes in the department of anatomy. The cadavers were embalmed immediately after death. The embalmed cadavers were labeled from 1 to 40, right and left limbs were labeled R and L, respectively. The limbs were dissected retaining continuity with the trunk. Exposure of the axillary artery and its branches were achieved following classical incisions and dissection procedures as provided by Cunningham’s manual of practical Anatomy (Romanes, 1992)4, taking care to preserve all arteries, sacrificing venae commitantes and resecting the muscles that come in their Figure 1. Lateral thoracic artery arising from subscapular artery on the way. The branching pattern of the axillary artery was stud- left side. Thoracoacromial trunk and its branches are absent. AA: axillary ied under