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Yamada S, Kawagishi K, Ishii T, Miyaso H, Yoshioka H, Matsuno Y, Mori Y, Kosaka J. Persistent median artery: paedogenesis of the antebrachial arterial system in the human body. Anat Sci Int 2024:10.1007/s12565-024-00799-x. [PMID: 39266906 DOI: 10.1007/s12565-024-00799-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Accepted: 09/02/2024] [Indexed: 09/14/2024]
Abstract
The persistence of the median artery in adult life, a remnant of the early brachial artery in the embryonic stage, has been reported in many anatomical and clinical studies. Herein, we aimed to investigate the prevalence and origin of the median artery in cadavers. We examined 53 adult Japanese cadavers and carefully dissected 106 upper limbs, and the arterial systems in the forearms and hands were observed macroscopically. We found the palmar type of the median artery on 106 sides in 53 cadavers, and found that it passes through the carpal tunnel and forms the superficial palmar arch in the hand in only two cadavers. The antebrachial type, ending in the forearm before reaching the wrist joint, was detected on 63 sides in 44 cadavers. The proportions of the origins of the median artery examined in this study were as follows: originating from the common interosseous artery (CIA) on 15 sides (23%), anterior interosseous artery (AIA) on 9 sides (14%), ulnar artery (UA) on 16 sides (24%), and CIA-UA trunk on 26 sides (39%). None arose from other arteries in the upper limbs. Based on our results and the current theory on vascular development, we conclude that the term 'persistent median artery' must be strictly used for the one that arises from the arteries in the forearm except for the radial artery, and the presence of this ontogenetic remnant can be interpreted as paedogenesis in the human body. We also describe that the increasing trend in the incidence of the median artery since the nineteenth century, as pointed out by a few researchers, may represent 'nearly neutral evolution' at the phenotypic level in human populations.
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Affiliation(s)
- Shinnosuke Yamada
- Faculty of Medicine, School of Medicine, International University of Health and Welfare, Narita Campus, Kozunomori 4-3, Narita City, Chiba Prefecture, 286-8686, Japan.
| | - Kyutaro Kawagishi
- Department of Anatomy and Structural Science, Faculty of Medicine, Yamagata University, Iidanishi 2-2-2, Yamagata City, Yamagata Prefecture, 990-9585, Japan
| | - Takaya Ishii
- Faculty of Medicine, School of Medicine, International University of Health and Welfare, Narita Campus, Kozunomori 4-3, Narita City, Chiba Prefecture, 286-8686, Japan
| | - Hidenobu Miyaso
- Department of Anatomy, Tokyo Medical University, Shinjuku 6-1-1. Shinjuku-Ku, Tokyo, 160-8402, Japan
| | - Hirotaka Yoshioka
- Faculty of Medicine, School of Medicine, International University of Health and Welfare, Narita Campus, Kozunomori 4-3, Narita City, Chiba Prefecture, 286-8686, Japan
| | - Yoshiharu Matsuno
- Basic Medicine Research Centre, International University of Health and Welfare, Narita Campus, Kozunomori 4-3, Narita City, Chiba Prefecture, 286-8686, Japan
| | - Yasutake Mori
- Faculty of Medicine, School of Medicine, International University of Health and Welfare, Narita Campus, Kozunomori 4-3, Narita City, Chiba Prefecture, 286-8686, Japan
| | - Jun Kosaka
- Faculty of Medicine, School of Medicine, International University of Health and Welfare, Narita Campus, Kozunomori 4-3, Narita City, Chiba Prefecture, 286-8686, Japan
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Eachempati KK, Parameswaran A, Yadav VK, Kumar RP, Ponnala VK, Apsingi S. Thrombosed Persistent Median Artery with Coexisting Bifid Median Nerve in a Robotic Arthroplasty Surgeon: A Case Report. JBJS Case Connect 2024; 14:01709767-202406000-00014. [PMID: 38635780 DOI: 10.2106/jbjs.cc.24.00071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
CASE A 47-year-old orthopaedic surgeon presented with acute volar left wrist pain. He performed over 250 robot-assisted knee arthroplasties each year. Color Doppler evaluation revealed bilateral persistent median arteries and bifid median nerves, with focal occlusive thrombosis of the left median artery. He was advised rest and oral aspirin. He could return to his professional activities after 1 month. He had no recurrence of symptoms at 1 year of follow-up. CONCLUSION Orthopaedic surgeons use vibrating hand tools on a daily basis. The possibility of hand-arm vibration syndrome must be considered in the differential diagnosis of wrist pain among orthopaedic surgeons.
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Berškys I, Suchomlinov A. Prevalence and Variations of the Median Artery: A Pilot Study in a Sample of Lithuanian Cadavers. Cureus 2024; 16:e57140. [PMID: 38681388 PMCID: PMC11055626 DOI: 10.7759/cureus.57140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2024] [Indexed: 05/01/2024] Open
Abstract
Objective This pilot project aimed to assess the prevalence and variations of the median artery (MA) on a small scale in preparation for a large-scale study investigating MA in Lithuanian cadavers. Methods Eight formalin-fixed adult female cadavers were used in this study. Dissection was performed to allow for the observation of MA presence, type, origin, termination, and relations with other structures. The gathered data was analyzed, and a literature search was performed to compare the findings. Results MA was found in 10 of the 16 upper limbs examined; therefore, the incidence of MA in the present study was 62.5%. Of the 10 MAs found, six (60%) were of the antebrachial type (a-MA), and four (40%) were palmar (p-MA). Thus, the prevalence of a-MA and p-MA in the upper limbs examined was 37.5% (N = 6/16) and 25% (N = 4/16), respectively. Among the six cadavers that were found to possess MA, it was identified bilaterally in four (66.7%) and unilaterally in two (33.3%). The associations between the antimere and the presence of MA or MA-type were not statistically significant. MA most commonly originated from the common interosseous artery (50%, N = 5/10), followed by the ulnar artery (UA) (40%, N = 4/10), and the anterior interosseous artery (10%, N = 1/10). Two (33.3%) of the six a-MAs terminated in the mid-forearm, while four (66.7%) a-MAs ended in the distal forearm. Meanwhile, three (75%) of the four p-MAs terminated by joining the UA, while one (25%) terminated as the first common palmar digital artery. In the forearm, nine (90%) of the 10 MAs traveled anteriorly to the anterior interosseous nerve (AIN), and only one (10%) traveled posteriorly to the AIN. Additionally, one (10%) of the 10 MAs was found to pierce the median nerve. Conclusions Our findings confirm the variability in MA characteristics reported by previous studies. The high incidence of MA discovered in our sample calls attention to the importance of being aware of MA in a clinical setting, as this would allow for a timely and accurate response to a potential pathology associated with this structure.
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Affiliation(s)
- Ignas Berškys
- Department of Anatomy, Histology, and Anthropology, Vilnius University Faculty of Medicine, Vilnius, LTU
| | - Andrej Suchomlinov
- Department of Anatomy, Histology, and Anthropology, Vilnius University Faculty of Medicine, Vilnius, LTU
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Simić M, Bumbaširević M, Jović D, Bogosavljević N, Vujačić M, Erić D, Boljanović J, Milisavljević M, Dožić A, Ćetković M. Persistent median artery and communicating branch related to the superficial palmar arch. Sci Rep 2024; 14:222. [PMID: 38167619 PMCID: PMC10762056 DOI: 10.1038/s41598-023-50935-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 12/28/2023] [Indexed: 01/05/2024] Open
Abstract
Microvascular surgery, plastic and reconstructive hand surgery, and coronary artery bypass surgery call for a microanatomical study of the branching pattern of the superficial palmar arch (SPA). For the anatomical analysis, we used a group of 20 dissected human hands injected with 4% formaldehyde solution and a 10% mixture of melted gelatin and India ink. The morphometric study was performed on 40 human hands of adult persons injected with methyl-methacrylate fluid into the ulnar and radial arteries simultaneously and afterwards corroded in 40% KOH solution for the preparation of corrosion cast specimens. The mean diameter of the SPA, between the second and third common palmar digital arteries, was 1.86 ± 0.08 mm. We identified the persistent median artery (PMA) in 5% of hands. We distinguished the three main groups of the SPAs according to variations in morphology and branching of the arch: Type 1, the long SPA; Type 2, the middle length SPA; and Type 3, the short SPA found in 27.5% of specimens. The communicating branch (CB), a vessel interconnecting the SPA to the closest branch of the radial artery, is classified into two different morphological groups. The third type of incomplete short arterial arch is the most important of the three groups of SPAs. That short SPA is potentially inadequate for restoring circulation after occlusion or radial artery harvesting for coronary artery bypass.
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Affiliation(s)
- Marko Simić
- Clinic for Orthopedic Surgery and Traumatology, University Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
| | - Marko Bumbaširević
- Clinic for Orthopedic Surgery and Traumatology, University Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Darko Jović
- Clinic of Plastic and Reconstructive Surgery, University Clinical Centre of Republic of Srpska, Banja Luka, Republic of Srpska, Bosnia and Herzegovina
| | - Nikola Bogosavljević
- Institute for Orthopedic Surgery "Banjica", Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Marko Vujačić
- Institute for Orthopedic Surgery "Banjica", Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Dražan Erić
- Department of Plastic and Reconstructive Surgery, Al Emadi Hospital, Doha, Qatar
| | - Jelena Boljanović
- Laboratory for Vascular Morphology, Institute of Anatomy, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Milan Milisavljević
- Laboratory for Vascular Morphology, Institute of Anatomy, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Academy of Medical Sciences, Serbian Medical Association, Belgrade, Serbia
| | - Aleksandra Dožić
- Institute of Anatomy, Faculty of Dental Medicine, University of Belgrade, Belgrade, Serbia.
| | - Mila Ćetković
- Institute of Histology and Embryology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
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Belbl M, Steyerova P, Kachlik D. Two arterial variations of the hand and wrist present bilaterally (persistent median artery and superficial dorsal branch of the radial artery): ultrasound findings. Surg Radiol Anat 2024; 46:85-89. [PMID: 38006408 DOI: 10.1007/s00276-023-03262-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 10/25/2023] [Indexed: 11/27/2023]
Abstract
PURPOSE Arterial variations of the upper limb may bear high importance for many clinical procedures, including the use of flaps in plastic surgery. We present a feasible way for visualization and confirmation of presence of these variations. METHODS All variations were detected by ultrasonography and confirmed by Color Doppler Imaging. Proper documentation was taken in order to present our findings. RESULTS We report a case of a 19-year-old female who showed two concomitant arterial variations of the forearm and the hand bilaterally. These two variations were the persistent median artery and the superficial dorsal branch of the radial artery which both significantly contributed to the blood supply of the hand. All examinations were performed by the same investigator and all findings were reviewed by an experienced sonographist. CONCLUSION An unusual arrangement of the arterial system can be easily detected. We present a feasible way to prevent iatrogenic injuries and increase utilization of anatomical variants knowledge in surgery by using ultrasound prior to planning surgical procedures.
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Affiliation(s)
- Miroslav Belbl
- Department of Anatomy, Second Faculty of Medicine, Charles University, V Uvalu 84, 150 06, Prague 5-Motol, Czech Republic.
- Second Faculty of Medicine, Center for Endoscopic, Surgical and Clinical Anatomy (CESKA), Charles University, Prague, Czech Republic.
| | - Petra Steyerova
- Second Faculty of Medicine, Center for Endoscopic, Surgical and Clinical Anatomy (CESKA), Charles University, Prague, Czech Republic
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - David Kachlik
- Department of Anatomy, Second Faculty of Medicine, Charles University, V Uvalu 84, 150 06, Prague 5-Motol, Czech Republic
- Second Faculty of Medicine, Center for Endoscopic, Surgical and Clinical Anatomy (CESKA), Charles University, Prague, Czech Republic
- Department of Health Care Studies, College of Polytechnics, Jihlava, Czech Republic
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Tee QX, Stuckey S, Lau KK. Persistent median artery on computed tomographic arteriovenous fistulograms in patients on haemodialysis. J Med Imaging Radiat Oncol 2023; 67:612-618. [PMID: 37277645 DOI: 10.1111/1754-9485.13544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 05/17/2023] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Cadaveric studies suggest an increasing prevalence of the persistent median artery (PMA) over a prolonged timeframe. The aim of this retrospective cross-sectional study was to evaluate the PMA prevalence in haemodialysis patients who had computed tomographic fistulograms (CTFs), and if present, their calibres and origins. METHODS All consecutive adult patients referred for an upper limb CTFs for assessment of arteriovenous fistula (AVF) dysfunction from 2006 to 2021 were included. Patients whose CTF did not include the forearm were excluded. PMA was identified as an artery running alongside the median nerve between flexor digitorum superficialis and flexor digitorum profundus. Patient demographics, presence of PMA including size and origin were recorded. RESULTS A PMA was found in 91/170 (53.5%) CTFs (7:3 male-to-female ratio, mean age 71-years). When stratified by age, prevalence increased with decreasing age; 51% in >70-year-olds, 54% in 50-70-year-olds and 67% in <50-year-olds. The average PMA diameter was 2.2 mm proximally and 1.8 mm distally. No stenosis was observed in the PMAs. CONCLUSION The PMA prevalence appears to increase with decreasing age and is a frequently encountered anatomical variant. Radiologists assessing forearm vasculature need to be aware of this anatomical variant and potentially include it in their future reports. Further research into the PMA may make its potential use as arterial conduits for AVF, potential donor grafts for coronary artery bypass surgery or additional vascular access options possible. Whether the reducing prevalence with age reflects an overall increasing prevalence is yet to be determined.
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Affiliation(s)
- Qiao Xin Tee
- Monash Imaging, Monash Health, Clayton, Victoria, Australia
| | - Stephen Stuckey
- Department of Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Kenneth K Lau
- Monash Imaging, Monash Health, Clayton, Victoria, Australia
- School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, Faculty of Medicine, University of Melbourne, Clayton, Victoria, Australia
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Honis HR, Gruber H, Honold S, Konschake M, Moriggl B, Brenner E, Skalla-Oberherber E, Loizides A. Anatomical considerations of US-guided carpal tunnel release in daily clinical practice. J Ultrason 2023; 23:e131-e143. [PMID: 37732109 PMCID: PMC10508271 DOI: 10.15557/jou.2023.0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 04/28/2023] [Indexed: 09/22/2023] Open
Abstract
Carpal tunnel syndrome is the most frequent compression neuropathy with an incidence of one to three subjects per thousand. As specific anatomical variations might lead to unintended damage during surgical interventions, we present a review to elucidate the anatomical variability of the carpal tunnel region with important considerations for daily clinical practice: several variants of the median nerve branches in and around the transverse carpal ligament are typical and must - similarly to the variant courses of the median artery, which may be found eccentric ulnar to the median nerve - be taken into account in any interventional therapy at the carpal tunnel. Unintended interference in these structures might lead to heavy arterial bleeding and, in consequence, even underperfusion of segments of the median nerve or, if neural structures such as variant nerve branches are impaired or even cut, severe pain-syndromes with a profound impact on the quality of life. This knowledge is thus crucial for outcome- and safety-optimization of different surgical procedures at the volar aspect of the wrist and surgical therapy of the carpal tunnel syndrome e.g., US-guided carpal tunnel release, as injury might result in dysfunction and/or pain on wrist motion or direct impact in the region concerned. For most variations, anatomical and surgical descriptions vary, as official classifications are still lacking.
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Affiliation(s)
- Hanne-Rose Honis
- Institute of Clinical and Functional Anatomy, Medical University Innsbruck, Innsbruck, Austria
| | - Hannes Gruber
- Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
| | - Sarah Honold
- Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
| | - Marko Konschake
- Institute of Clinical and Functional Anatomy, Medical University Innsbruck, Innsbruck, Austria
| | - Bernhard Moriggl
- Institute of Clinical and Functional Anatomy, Medical University Innsbruck, Innsbruck, Austria
| | - Erich Brenner
- Institute of Clinical and Functional Anatomy, Medical University Innsbruck, Innsbruck, Austria
| | | | - Alexander Loizides
- Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
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Elhossiny AH, Bakir M, Dawalibi A, Behiery A. Persistent Median Artery, Bifid Median Nerve, and Reversed Palmaris Longus Encountered During Cadaveric Dissection: The First Reported Case. Cureus 2023; 15:e40324. [PMID: 37456408 PMCID: PMC10343151 DOI: 10.7759/cureus.40324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2023] [Indexed: 07/18/2023] Open
Abstract
The median artery is a transient embryological structure that normally disappears with the development of the radial and ulnar arteries. In rare instances, though, it persists as the persistent median artery (PMA). The superficial and deep palmar arches are formed through the anastomoses of the radial and ulnar arteries, giving hand and digits their main blood supply. This complex network of vessels and their anastomoses are prone to anatomical variations based on how the anastomosis occurs and which arteries contribute to this anastomosis. While it normally forms through the anastomosis of the radial and ulnar arteries, the superficial palmar arch (SPA) may also form differently, as in our case here, where the median artery persisted and branched off the radial artery, anastomosing with the ulnar artery to give rise to the SPA. This may also interfere with the normal compartmental architecture within the hand, possibly contributing to various clinical pathologies like carpal tunnel syndrome (CTS). Notably, in addition to the persistent median artery, our findings revealed a reversed palmaris longus and a bifid median nerve. These two additional variations can potentially exacerbate the risk of CTS. Alone, the coexistence of the PMA and the reversed palmaris longus is deemed a rare anomaly, only reported once in the literature. The addition of a third variation to the existing ones, like the bifid median nerve, is first reported by us and calls for more investigation for a possible genetic mutation. In this case, we report a persistent median artery, reversed palmaris longus muscle, and bifid median nerve in the forearm of a male cadaver found during a routine anatomy teaching session.
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Affiliation(s)
| | - Mohamad Bakir
- College of Medicine, Alfaisal University, Riyadh, SAU
| | | | - Ayman Behiery
- Department of Anatomy, Alfaisal University, Riyadh, SAU
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Miyashima Y, Gotani H, Okamoto K, Yagi H, Tanaka Y. Median Nerve Neuropathy Caused by Persistent Median Artery Thrombosis. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e4916. [PMID: 37359247 PMCID: PMC10287125 DOI: 10.1097/gox.0000000000004916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 02/16/2023] [Indexed: 06/28/2023]
Abstract
Persistent median artery thrombosis mimicking carpal tunnel syndrome is rare. Here, we report the pathological, ultrasonography, and intraoperative findings of a case of persistent median artery thrombosis mimicking carpal tunnel syndrome. A 34-year-old man reported to our clinic with a complaint of numbness in his left thumb, index finger, and middle finger, which are innervated by the left median nerve. He also reported that he felt pain in his left wrist and distal forearm while working. Although findings of the usual provocative tests and nerve conduction studies were normal, ultrasonography revealed arterial thrombosis at the carpal tunnel level, whereas magnetic imaging showed persistent median artery thrombosis in the carpal tunnel. Three months after surgical resection of the thrombosed section of the artery, the patient fully recovered with no residual pain or limitations in the use of the affected arm. His patient-reported outcomes improved as well. It is important to investigate the existence of persistent median artery thrombosis if a patient presents with atypical symptoms of carpal tunnel syndrome. Ultrasonography is useful for the diagnosis of persistent median artery thrombosis. Surgical resection of a thrombosed persistent median artery in patients with carpal tunnel syndrome yields good results.
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Affiliation(s)
- Yusuke Miyashima
- From the Department of Orthopedic Surgery, Japan Seafarers Relief Association Osaka Ekisaikai Hospital, Osaka, Japan
| | - Hiroyuki Gotani
- From the Department of Orthopedic Surgery, Japan Seafarers Relief Association Osaka Ekisaikai Hospital, Osaka, Japan
| | - Kotaro Okamoto
- From the Department of Orthopedic Surgery, Japan Seafarers Relief Association Osaka Ekisaikai Hospital, Osaka, Japan
| | - Hirohisa Yagi
- From the Department of Orthopedic Surgery, Japan Seafarers Relief Association Osaka Ekisaikai Hospital, Osaka, Japan
| | - Yoshitaka Tanaka
- From the Department of Orthopedic Surgery, Japan Seafarers Relief Association Osaka Ekisaikai Hospital, Osaka, Japan
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Anatomical variations of the superficial palmar arch in human fetuses. Anat Sci Int 2023; 98:123-135. [PMID: 35927551 DOI: 10.1007/s12565-022-00679-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 07/24/2022] [Indexed: 01/20/2023]
Abstract
The superficial palmar arch is an important anatomical structure that contributes to the arterial supply of the palmar side of the hand in the upper extremity. However, there is limited information on the embryological morphological structure of the superficial palmar arch in the literature. We studied the types of the superficial palmar arch and determined their variations by dissecting 80 upper extremities of 40 formalin-fixed human fetuses (19 males, 21 females) 18-37 weeks of age. The types and variations of the superficial palmar arch were examined, and the median artery was imaged. The superficial palmar arch type was complete in 58 hands (72.5%) and incomplete in 22 hands (27.5%). The complete group consisted of type A (47.5%), type B (16.25%), type C (3.75%), type D (1.25%), and type E (3.75%). On the other hand, the incomplete group consisted of type F (15%), type G (8.75%), type H (2.5%), and type I (1.25%). A median artery that originated from the ulnar artery and passed through the carpal tunnel during its course was detected in two hands (2.5%). Knowledge of the superficial palmar arch variations will contribute to hand microsurgery particularly in vascular graft and free flap application interventions for arterial bleeding in the palmar region.
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11
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Cadaveric study of division of the median nerve by the persistent median artery. Surg Radiol Anat 2022; 44:1455-1460. [DOI: 10.1007/s00276-022-03035-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 10/13/2022] [Indexed: 11/26/2022]
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Barr ML, Jain NS, Ghareeb PA, Benhaim P. Persistent Median Artery Thrombosis Causing a Bifid Median Nerve and Carpal Tunnel Syndrome: A Case Report. JBJS Case Connect 2022; 12:01709767-202212000-00005. [PMID: 36206366 DOI: 10.2106/jbjs.cc.22.00424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 08/07/2022] [Indexed: 06/16/2023]
Abstract
CASE In this report, we describe a 41-year-old woman with symptoms concerning for acute carpal tunnel syndrome. Operative exploration resulted in resection of an aneurysmal, thrombosed, persistent median artery seen on preoperative imaging and full recovery by the patient. CONCLUSION A persistent median artery is an uncommon congenital hand condition resulting from the failure of the median artery to regress, which can then travel through the carpal tunnel and be associated with a bifid median nerve, irritation of the nerve, and need for surgical exploration if it thromboses, which is rare. This should be considered in patients with acute median nerve compression, without other etiologies.
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Affiliation(s)
- Meaghan L Barr
- Division of Plastic and Reconstructive Surgery, University of California, Los Angeles
| | - Nirbhay S Jain
- Division of Plastic and Reconstructive Surgery, University of California, Los Angeles
| | - Paul A Ghareeb
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Emory University
| | - Prosper Benhaim
- Division of Plastic and Reconstructive Surgery, University of California, Los Angeles
- Department of Orthopaedic Surgery, University of California, Los Angeles
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Muacevic A, Adler JR. A Unique Branching Pattern of the Brachial Artery: Coexisting Superficial Ulnar Artery and Persistent Median Artery. Cureus 2022; 14:e29882. [PMID: 36348890 PMCID: PMC9629875 DOI: 10.7759/cureus.29882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2022] [Indexed: 11/30/2022] Open
Abstract
The presence of both a superficial ulnar artery (SUA) and persistent median artery (PMA) of antebrachial type is of both clinical and surgical significance. In an 84-year-old female cadaver received through the Gift Body Program at Saint Louis University School of Medicine, the right brachial artery was seen divided into an SUA and radial artery (RA) slightly below the interepicondylar line of the humerus. At the level of the radial neck, the RA sent out the common interosseous artery that then gave off the radial recurrent artery before bifurcating into anterior interosseous artery (AIA) and posterior interosseous artery. The AIA continued to appear to branch into the anterior ulnar recurrent artery and posterior ulnar recurrent artery, as well as a PMA of the antebrachial type. In the hand, the SUA and RA contributed to the complete superficial palmar arch seemingly equally, and the RA was the dominant contribution to the deep palmar arch. Ninety-one other arms were assessed for this variation, and none were observed. Knowledge of an anatomical variation such as this may lead to decreased complications in the planning of surgical bypass grafting.
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Percutaneous Ultrasound-Guided Release of the Lacertus Fibrosus for Median Nerve Entrapment at the Elbow. Cardiovasc Intervent Radiol 2022; 45:1198-1202. [PMID: 35384488 DOI: 10.1007/s00270-022-03123-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 03/12/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE The aim of this technical note is to present a microinvasive percutaneous ultrasound-guided release of the lacertus fibrosus of the biceps brachii for pronator syndrome, i.e., entrapment of the median nerve at the elbow. METHODS Fifteen consecutive patients were included. Patients showed isolated pronator syndrome including pain plus reduced strength of specific median nerve innervated muscles. The release was performed in a non-operating interventional room under wide-awake local anesthesia no tourniquet (WALANT). It was conducted superficial to the pronator teres with in-plane ultrasound guidance. The recovery of strength was first assessed peroperatively, and then systematic visits at postoperative weeks 1 and 4 included assessments of both strength and pain. RESULTS Procedures were comfortably completed with no immediate surgical or anesthetic complication. Muscle strength returned immediately and persisted at postoperative visits. Visual analog scores for pain reduced from 6.2 to 2.5 and 0.6 at weeks 1 and 4, respectively. All working patients were able to perform in their professional activities at week 1. The millimetric skin incision healed with no hypertrophic scar tissue. A small hematoma occurred at week 1 and resorbed spontaneously. No other delayed complication was observed. The procedure appeared effective with improved invasiveness compared to existing techniques. Real-time monitoring with ultrasound may improve the safety. The technique could be regarded as a new ultrasound-guided alternative to surgery. CONCLUSION Performed superficial to the pronator teres muscle under WALANT anesthesia, the microinvasive percutaneous ultrasound-guided release of the lacertus fibrosus may be an effective treatment of pronator syndrome.
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Gürkan O, Çengel F, Erdem U, Yılmaz A, Polat A, Ekin E. The persistent median artery: A new challenger in carpal tunnel imaging? J ANAT SOC INDIA 2022. [DOI: 10.4103/jasi.jasi_114_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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16
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Roux J, Kohn MA, Sinskey J, Nguyen H, Boor M, Rouine-Rapp K. The ulnar artery: A site suitable for arterial cannulation in pediatric patients. Paediatr Anaesth 2021; 31:1357-1363. [PMID: 34644423 DOI: 10.1111/pan.14311] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 10/01/2021] [Accepted: 10/07/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Historically, the ulnar artery has rarely been considered for arterial cannulation as it is less easily palpated than the radial artery. With the current routine use of ultrasound in pediatric patients, the ulnar is as accessible as the radial and could be viewed as an equivalent site for cannulation. AIMS The purpose of this study was to compare ulnar and radial artery suitability for arterial cannulation in pediatric patients using 2-dimensional ultrasound. METHODS We examined the ulnar and radial arteries of pediatric patients aged birth to 6 years who were scheduled to undergo general anesthesia. Following anesthesia induction, the investigators positioned the patient's wrist to 30-45 degrees of extension and obtained images of the ulnar and radial arteries in the transverse and longitudinal planes. Assessments of the arteries' anterior-posterior diameter, cross-sectional area and depth were made by visual inspection at the time of image acquisition and by electronic caliper measurement of recorded images. RESULTS In 108 patients, mean anterior-posterior diameter of the ulnar artery was larger than the radial artery in the transverse view, longitudinal view, and cross-sectional area in 63.6%, 59.4%, and 60.4% of patients (p = .002, .004, and .006, respectively). Mean ulnar artery size was, on average, larger than the radial artery by 7.7%, 8.1%, and 12.9% in the transverse AP diameter, longitudinal AP diameter, and cross-sectional area (95% CI 3.1-12.4%; 3.2-13.0%; 4.4-21.5%). The investigator's visual evaluation of vessel size at the bedside showed substantial agreement with the measured cross-sectional area (linear-weighted kappa of 0.73). In a subset of 13 patients age <24 months, the mean depth of the ulnar artery was 2.13 mm compared to 1.65 mm for the radial artery (difference -0.48 mm 95% CI 1.08-0.12). CONCLUSIONS The ulnar artery was larger than the radial artery in 60% of pediatric patients thus may offer an arterial cannulation site advantage due to its larger size. The use of 2-dimensional ultrasound examination allows accurate assessment of upper extremity distal arteries in order to optimize site selection for arterial cannulation in pediatric patients.
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Affiliation(s)
- Jennifer Roux
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, California, USA
| | - Michael A Kohn
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Jina Sinskey
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, California, USA
| | - Hung Nguyen
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, California, USA
| | - Marjorie Boor
- Department of Pediatric Echocardiography, University of California, San Francisco, California, USA
| | - Kathryn Rouine-Rapp
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, California, USA
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17
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Radial forearm free flap in a patient with an unusual radial artery variation: a case report. Arch Plast Surg 2021; 48:646-650. [PMID: 34818712 PMCID: PMC8627948 DOI: 10.5999/aps.2021.00486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 08/06/2021] [Indexed: 11/28/2022] Open
Abstract
Head and neck reconstruction poses unique challenges in rehabilitating surgical defects in terms of integrity, function, and form. The radial forearm free flap (RFFF) has been widely used for defect coverage, especially in the head and neck area, but its versatility allows it to be used for soft-tissue reconstruction in various parts of the body. The vascular features of the flap are quite constant and reliable. Nevertheless, abnormalities of the forearm vascular tree have been described over the decades. We report a case of intraoral reconstruction after verrucous carcinoma recurrence in a 74-year-old woman with an unusual forearm flap, which we called the median forearm free flap, based on a median branch of the radial artery that was preoperatively detected using handheld Doppler ultrasonography. The distally located skin paddle was predominantly supplied by the aberrant median vessel with its perforators. The flap was thus safely harvested with this atypical pedicle. Successful reconstruction of the intraoral defect was achieved, with an uneventful postoperative course.
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18
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Solewski B, Lis M, Pękala JR, Brzegowy K, Lauritzen SS, Hołda MK, Walocha JA, Tomaszewski KA, Pękala PA, Koziej M. The persistent median artery and its vascular patterns: A meta-analysis of 10,394 subjects. Clin Anat 2021; 34:1173-1185. [PMID: 34371525 DOI: 10.1002/ca.23770] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 07/17/2021] [Accepted: 07/23/2021] [Indexed: 12/26/2022]
Abstract
The presence of a persistent median artery (PMA) has been implicated in the development of compression neuropathies and surgical complications. Due to the large variability in the prevalence of the PMA and its subtypes in the literature, more awareness of its anatomy is needed. The aim of our meta-analysis was to find the pooled prevalence of the antebrachial and palmar persistent median arteries. An extensive search through the major databases was performed to identify all articles and references matching our inclusion criteria. The extracted data included methods of investigation, prevalence of the PMA, anatomical subtype (antebrachial, palmar), side, sex, laterality, and ethnicity. A total of 64 studies (n = 10,394 hands) were included in this meta-analysis. An antebrachial pattern was revealed to be more prevalent than a palmar pattern (34.0% vs. 8.6%). A palmar PMA was reported in 2.6% of patients undergoing surgery for carpal tunnel syndrome when compared to cadaveric studies of adult patients in which the prevalence was 8.6%. Both patterns of PMA are prevalent in a considerable portion of the general population. As the estimated prevalence of the PMA was found to be significantly lower in patients undergoing surgery for carpal tunnel syndrome than those reported in cadaveric studies, its etiological contribution to carpal tunnel syndrome is questionable. Surgeons operating on the forearm and carpal tunnel should understand the anatomy and surgical implications of the PMA and its anatomical patterns.
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Affiliation(s)
- Bernard Solewski
- International Evidence-Based Anatomy Working Group, Kraków, Poland.,Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Maciej Lis
- International Evidence-Based Anatomy Working Group, Kraków, Poland.,Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Jakub R Pękala
- International Evidence-Based Anatomy Working Group, Kraków, Poland.,Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Karolina Brzegowy
- International Evidence-Based Anatomy Working Group, Kraków, Poland.,Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Sigurd S Lauritzen
- International Evidence-Based Anatomy Working Group, Kraków, Poland.,Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Mateusz K Hołda
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland.,Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK
| | - Jerzy A Walocha
- International Evidence-Based Anatomy Working Group, Kraków, Poland.,Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Krzysztof A Tomaszewski
- International Evidence-Based Anatomy Working Group, Kraków, Poland.,Department of Orthopaedics, Scanmed St. Raphael Hospital, Kraków, Poland.,Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, Kraków, Poland
| | - Przemysław A Pękala
- International Evidence-Based Anatomy Working Group, Kraków, Poland.,Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland.,Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, Kraków, Poland
| | - Mateusz Koziej
- International Evidence-Based Anatomy Working Group, Kraków, Poland.,Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
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19
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Osiak K, Elnazir P, Mazurek A, Pasternak A. Prevalence of the persistent median artery in patients undergoing surgical open carpal tunnel release: A case series. TRANSLATIONAL RESEARCH IN ANATOMY 2021. [DOI: 10.1016/j.tria.2021.100113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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20
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Kumaratilake J, Lucas T, Henneberg M. Possible relationship of upper limb arteries, median and brachial to the twelfth meridian of the human upper limb. J Anat 2021; 238:1492-1493. [PMID: 33521956 PMCID: PMC8128757 DOI: 10.1111/joa.13401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 01/11/2021] [Indexed: 11/30/2022] Open
Abstract
Approximate location of the 12th meridian in the hand and the forearm in relation to median artery and median nerve.
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Affiliation(s)
- Jaliya Kumaratilake
- Discipline of Anatomy and PathologyAdelaide Medical SchoolUniversity of AdelaideAdelaideSAAustralia
- Biological Anthropology and Comparative Anatomy Research UnitAdelaide Medical SchoolUniversity of AdelaideAdelaideSAAustralia
| | - Teghan Lucas
- ArchaeologyFlinders UniversityAdelaideSAAustralia
| | - Maciej Henneberg
- Discipline of Anatomy and PathologyAdelaide Medical SchoolUniversity of AdelaideAdelaideSAAustralia
- Biological Anthropology and Comparative Anatomy Research UnitAdelaide Medical SchoolUniversity of AdelaideAdelaideSAAustralia
- ArchaeologyFlinders UniversityAdelaideSAAustralia
- Institute of Evolutionary MedicineUniversity of ZurichZurichSwitzerland
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21
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Calderón Ardila D, Larrota DRB, Ardila MAC, Acuña LEB. Traumatic injury of radial and ulnar artery with perfusion of the hand through the median artery: a case report. Colomb Med (Cali) 2021; 52:e5024521. [PMID: 34188329 PMCID: PMC8216046 DOI: 10.25100/cm.v52i2.4521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Case description: A young male patient with a complete section of the ulnar and radial arteries preserved the perfusion of the hand through an anatomical variant, the median artery, identified by angiotomography. Clinical Findings: A wound in the distal third of the left forearm with present pulses and adequate hand coloration. An angiotomography of the upper left limb showed a median artery originating as a continuation of the anterior interosseous artery and ending in the palm of the hand with an incomplete superficial palmar arch. Treatment and Outcomes: Ligation of both radial and ulnar arteries was performed. It was not possible to follow up the patient. Clinical Relevance: Forming the superficial and deep palmar arches, the irrigation of hand comes from the ulnar and radial arteries, which can compromise the viability of the limb when injured. The median artery is present in 0.6-21.1% of the population, originates from the anterior interosseous artery (branch of the ulnar), accompanies the median nerve in its path and ends in the palm joining the superficial palmar arch. Diagnostic imaging is a key tool for assessing arterial circulation and characterizing upper limb vascular lesions. Knowledge of the anatomical variations of the arterial supply of the hand, including variability of the superficial palmar arch, is crucial for the safety and success of hand surgeries.
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Affiliation(s)
- Daniela Calderón Ardila
- Universidad Industrial de Santander, Facultad de Salud, Especialización Cirugía Plástica Estética y Reconstructiva. Bucaramanga, Colombia
| | - Daniel Raúl Ballesteros Larrota
- Universidad Industrial de Santander, Facultad de Salud, Especialización Cirugía Plástica Estética y Reconstructiva. Bucaramanga, Colombia
| | - María Andrea Calderón Ardila
- Universidad del Rosario, Escuela de Medicina, Ciencias de la Salud, Especialización en Radiología. Bogotá, Colombia
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22
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Georgiev GP. Nerve entrapment vs. possible nerve entrapment in terms of meticulous description of potential possibility of nerve compression by variant anatomical structures in cadaver cases. Morphologie 2021; 106:70-71. [PMID: 33582006 DOI: 10.1016/j.morpho.2021.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 01/21/2021] [Indexed: 12/01/2022]
Affiliation(s)
- G P Georgiev
- Department of Orthopaedics and Traumatology, University Hospital Queen Giovanna - ISUL, Medical University of Sofia, 8, Bialo More Str., 1527 Sofia, Bulgaria.
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23
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Konarik M, Musil V, Baca V, Kachlik D. Upper limb principal arteries variations: A cadaveric study with terminological implication. Bosn J Basic Med Sci 2020; 20:502-513. [PMID: 32343941 PMCID: PMC7664784 DOI: 10.17305/bjbms.2020.4643] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 04/04/2020] [Indexed: 11/16/2022] Open
Abstract
Although the variability of the upper limb arteries is a clinically important problem, the prevalence is varying across the existing studies and classification is rather complicated, not well established and sometimes even unclear for simple and direct understanding and usage. Multiple case reports appearing in the last years apply incorrect, inappropriate, and sometimes misleading terminology. We performed an anatomical cadaveric study of the variability of the arteries of the upper limb, namely, the axilla, arm, and forearm, in 423 upper limbs embalmed with classical formaldehyde method (Central European population). We proposed to apply the Equality system based on the common trunks for denomination of the axillary artery branches principal variations: Truncus subscapulocircumflexus (22.9%), truncus profundocircumflexus (13.75%), and truncus bicircumflexus (13.95%). Further, we proposed the terminology system developed by Rodríguez-Niedenführ et al. for the free upper limb principal arterial trunk variations based on the origin, location (in the arm only, or in the arm and forearm), and course (related to the forearm flexor muscles) of the involved artery: Arteria brachialis superficialis (9.5%), arteria brachioradialis superficialis (6.4%), arteria brachioulnaris superficialis (1.9%), arteria brachiomediana superficialis (0.5%), and arteria comitans nervi mediani manus (3.3%). Extensive development of the catheterization methods via the arteria radialis et ulnaris as well as surgical procedures using flaps based on perforating branches of these arteries (including arteria brachioradialis superficialis et brachioulnaris superficialis) necessitate thorough data on prevalence of the variant vessels for safe performance of these procedures to prevent any unexpected situations or to react adequately in such.
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Affiliation(s)
- Marek Konarik
- Department of Anatomy, Second Faculty of Medicine, Charles University, Prague, Czech Republic; Department of Histology and Embryology, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Vladimir Musil
- Centre of Scientific Information, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Vaclav Baca
- Department of Health Care Studies, College of Polytechnics Jihlava, Jihlava, Czech Republic
| | - David Kachlik
- Department of Anatomy, Second Faculty of Medicine, Charles University, Prague, Czech Republic; Department of Histology and Embryology, Third Faculty of Medicine, Charles University, Prague, Czech Republic; Department of Health Care Studies, College of Polytechnics Jihlava, Jihlava, Czech Republic
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24
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Lucas T, Kumaratilake J, Henneberg M. Recently increased prevalence of the human median artery of the forearm: A microevolutionary change. J Anat 2020; 237:623-631. [PMID: 32914433 DOI: 10.1111/joa.13224] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 04/02/2020] [Accepted: 05/04/2020] [Indexed: 12/28/2022] Open
Abstract
The median artery has been considered as an embryonic structure, which normally regresses around the 8th week of gestation. However, various prevalences have been reported in adults since the 18th century. Furthermore, in a study by Henneberg and George (1995; Am J Phys Anthropol 96, 329-334), has suggested that increasing prevalence of the median artery during the 20th century was a 'possible secular trend'. The present study, conducted nearly a quarter of a century later, is a continuation of that study. A total of 26 median arteries were found in 78 upper limbs obtained from Australians aged 51 to 101 years, who died in the period 2015-2016, a prevalence rate of 33.3%. Analysis of the literature showed that the presence of the median artery has been significantly increasing (p = .001) over time, from approximately 10% in people born in the mid-1880s to approximately 30% by the end of the 20th century. The significance of the prevalence increased to a p value <.0001, when the results of the present study and other studies conducted by our research team were combined. After removal of the studies that were possibly biased, because of their specific focus on the evolutionary aspects of the median artery, the significance remained at p = .018. The present study provides an example of microevolutionary changes in the internal anatomy of the human body. Second-order polynomial regression of the median artery's prevalence on dates of birth shows that it is now present in 35% of people and predicts that people born 80 years from now will all carry a median artery if the trend continues. When the median artery prevalence reaches 50% or more, it should not be considered as a variant, but as a 'normal' human structure.
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Affiliation(s)
- Teghan Lucas
- School of Medical Sciences, Anatomy, University of New South Wales, Sydney, New South Wales, Australia.,Department of Archaeology, Flinders University, Adelaide, South Australia, Australia
| | - Jaliya Kumaratilake
- Biological Anthropology and Comparative Anatomy Research Unit, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia.,Discipline of Anatomy and Pathology, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Maciej Henneberg
- Biological Anthropology and Comparative Anatomy Research Unit, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia.,Discipline of Anatomy and Pathology, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia.,Institute of Evolutionary Medicine, University of Zurich, Zurich, Switzerland
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25
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Alexander JG, Leal MC, Baptista JDS. Persistent median artery inside the carpal tunnel: description and surgical implications. Autops Case Rep 2020; 10:e2020209. [PMID: 33344324 PMCID: PMC7703046 DOI: 10.4322/acr.2020.209] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The median artery is usually a transient vessel during the embryonic period. However, this artery can persist in adult life as the persistent median artery. This paper aims to describe this relevant anatomical variation for surgeons, review the literature and discuss its clinical implications. A routine dissection was performed in the upper left limb of a male adult cadaver of approximately 50-60 years of age, embalmed in formalin 10%. The persistent median artery was identified emerging as a terminal branch of the common interosseous artery with a path along the ulnar side of the median nerve. In the wrist, the persistent median artery passed through the carpal tunnel, deep in the transverse carpal ligament. The dissection in the palmar region revealed no anastomosis with the ulnar artery forming the superficial palmar arch. The common digital arteries emerged from the ulnar artery and the persistent median artery. Such variation has clinical and surgical relevance in approaching carpal tunnel syndrome and other clinical disorders in the wrist.
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Affiliation(s)
- João Gabriel Alexander
- Universidade Federal do Espírito Santo (UFES), Departamento de Morfologia, Laboratório de Estudos em Morfologia Aplicada (LEMA), Vitória, ES, Brasil
| | - Matheus Coelho Leal
- Universidade Federal do Espírito Santo (UFES), Departamento de Morfologia, Laboratório de Estudos em Morfologia Aplicada (LEMA), Vitória, ES, Brasil
| | - Josemberg da Silva Baptista
- Universidade Federal do Espírito Santo (UFES), Departamento de Morfologia, Laboratório de Estudos em Morfologia Aplicada (LEMA), Vitória, ES, Brasil
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26
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Bartels DW, Shin AY. Surgical Excision of a Thrombosed Persistent Median Artery Causing Carpal Tunnel-Like Symptoms: A Case Report. JBJS Case Connect 2020; 10:e2000139. [PMID: 32910613 DOI: 10.2106/jbjs.cc.20.00139] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
CASE A 51-year-old man presented with pain and paresthesias in the median nerve distribution and a subjective loss of grip strength. Imaging revealed a thrombosed persistent median artery in the carpal tunnel abutting the median nerve. The thrombosed portion of the artery was surgically excised, and the patient experienced resolution of symptoms. CONCLUSION Persistent median artery thrombosis is rare and can cause carpal tunnel syndrome. Ultrasound is a useful tool for diagnosis and appropriate surgical planning. Although treatment with systemic anticoagulation is an option, surgical excision resulted in resolution of symptoms and an excellent short-term outcome.
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Affiliation(s)
- Douglas W Bartels
- 1Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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Schloßhauer T, Kueenzlen L, Rothenberger JM, Sader R, Rieger UM. Erfolgreiche freie mikrovaskuläre A. radialis-Lappenplastik zur Phalluskonstruktion bei persistierender A. mediana (PMA). HANDCHIR MIKROCHIR P 2020; 52:280-288. [DOI: 10.1055/a-1150-7517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Zusammenfassung
Hintergrund Anomalien des Gefäßsystems des Unterarmes können bei der mikrochirurgischen Hebung einer A. radialis-Lappenplastik von großer Bedeutung sein. Insbesondere bei der Verwendung der fasziokutanen Radialislappenplastik zur Bildung eines Penoids ist auf Grund der erforderlichen Größenausmaße der Lappenplastik eine suffiziente arterielle Versorgung von grundlegender Bedeutung. Beim Auftreten einer persistierenden A. mediana können dabei die Perfusionsverhältnisse im Versorgungsgebiet der A. radialis und der A. ulnaris verändert oder diese sogar vollständig rückgebildet worden sein.
Patienten und Methoden Es erfolgte eine retrospektive Auswertung aller in unserer Klinik durchgeführten Phalloplastiken mit Radialispenoid von Januar 2016 bis Dezember 2018. Bei allen Patienten wurde die Technik nach Gottlieb und Levine oder nach Chang angewandt.
Ergebnisse In der retrospektiv untersuchten Kohorte von 48 Patienten wurde bei zwei Patienten intraoperativ eine persistierende A. mediana gefunden, was einer Inzidenz von 4,2 % entspricht. Bei beiden Patienten gelang die hinsichtlich der Perfusion komplikationslose Bildung eines Radialispenoids ohne Einschränkungen der Lappenperfusion oder der Perfusion der Hand. Eine Literaturübersicht liefert einen Überblick über die Inzidenz auftretender Aberrationen der Vaskularisierung des Unterarmes und die daraus ableitbaren Konsequenzen für die Planung einer A. radialis-Lappenplastik.
Schlussfolgerung Auch im Falle einer verlässlichen mikrochirurgischen Lappenplastik wie der A. radialis-Lappenplastik sollten dem mikrochirurgisch tätigen Chirurgen die Möglichkeiten der anatomischen Varianten der arteriellen Versorgung des Unterarmes, wie das Vorhandensein einer persistierenden A. mediana, bekannt sein. Der standardmäßig durchzuführende Allen-Test liefert in vielen Fällen keine eindeutige Rückschlussmöglichkeit und bedingt somit häufig erst intraoperative Zufallsbefunde. Eine sorgfältige präoperative Planung und Evaluation der Perfusion sowie die Erörterung von Alternativtechniken sind hierbei notwendig.
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Affiliation(s)
- Torsten Schloßhauer
- AGAPLESION MARKUS KRANKENHAUS, Akademisches Lehrkrankenhaus der Johann Wolfgang Goethe-Universität Frankfurt am Main, Klinik für Plastische, Ästhetische, Wiederherstellungs- und Handchirurgie
- AGAPLESION EV Krankenhaus Mittelhessen, Akademisches Lehrkrankenhaus der Justus-Liebig-Universität Gießen, Klinik für Plastische, Ästhetische, Rekonstruktive und Handchirurgie
| | - Lara Kueenzlen
- AGAPLESION MARKUS KRANKENHAUS, Akademisches Lehrkrankenhaus der Johann Wolfgang Goethe-Universität Frankfurt am Main, Klinik für Plastische, Ästhetische, Wiederherstellungs- und Handchirurgie
| | - Jens Martin Rothenberger
- AGAPLESION MARKUS KRANKENHAUS, Akademisches Lehrkrankenhaus der Johann Wolfgang Goethe-Universität Frankfurt am Main, Klinik für Plastische, Ästhetische, Wiederherstellungs- und Handchirurgie
| | - Robert Sader
- Goethe-Universitat Frankfurt am Main, Klinik für Mund-, Kiefer-, Plastische Gesichtschirurgie
| | - Ulrich Michael Rieger
- AGAPLESION MARKUS KRANKENHAUS, Akademisches Lehrkrankenhaus der Johann Wolfgang Goethe-Universität Frankfurt am Main, Klinik für Plastische, Ästhetische, Wiederherstellungs- und Handchirurgie
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Soubeyrand M, Melhem R, Protais M, Artuso M, Crézé M. Anatomy of the median nerve and its clinical applications. HAND SURGERY & REHABILITATION 2020; 39:2-18. [DOI: 10.1016/j.hansur.2019.10.197] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 09/25/2019] [Accepted: 10/28/2019] [Indexed: 12/11/2022]
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Nishan B, Hudgi V, Krishna KS, Kiran IS, Motukuru V. Persistent thrombosed median artery – A rare cause for acute wrist pain: A case report and review of literature. INDIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2020. [DOI: 10.4103/ijves.ijves_93_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Buch C, Devora CM, Johnson LY, Rahimi OB, Kar R. Incomplete superficial palmar arch and bilateral persistent median artery. Int J Surg Case Rep 2019; 58:205-207. [PMID: 31078992 PMCID: PMC6515125 DOI: 10.1016/j.ijscr.2019.04.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 04/10/2019] [Accepted: 04/16/2019] [Indexed: 11/22/2022] Open
Abstract
Possible anatomical variations of the vascular supply for the hand. Screen patients for the presence of persistent median artery.
Introduction The superficial palmar arch (SPA) is a major source of blood supply to much of the hand and is conventionally formed by the anastomosis of the ulnar artery with the superficial branch of the radial artery. The SPA has been classified into complete or incomplete based on the presence or absence of anastomosis between the arteries contributing to the formation of this palmar arch. Case report Reported here is a unilateral presentation of incomplete superficial palmar arch. The ulnar artery (UA) gave off one proper palmar digital artery, which supplied the ulnar side of the little finger, and two common palmar digital arteries, which supplied the little, ring, and the middle finger. The superficial palmar branch of the radial artery gave off a proper palmar digital artery to the thumb, and two common palmar digital arteries, which supplied the thumb, index, and middle fingers. Apart from the presence of the incomplete SPA, persistent median arteries were also observed bilaterally in this cadaver. Discussion The prevalence of incomplete SPA has been reported to vary between 3.6–54.76%. To the best of our knowledge, this is the first case report describing an incomplete palmar arch and bilateral persistent median artery in a cadaver. Conclusion Patients should be screened for the presence of complete or incomplete SPA before harvesting the radial artery either for myocardial revascularization or for radial artery forearm flap to prevent ischemic complications in the hand.
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Affiliation(s)
- Chirag Buch
- Long School of Medicine, University of Texas Health at San Antonio, San Antonio, TX 78229, USA
| | - Candice M Devora
- Department of Cell Systems and Anatomy, University of Texas Health at San Antonio, San Antonio, TX 78229, USA
| | - Linda Y Johnson
- Department of Cell Systems and Anatomy, University of Texas Health at San Antonio, San Antonio, TX 78229, USA
| | - Omid B Rahimi
- Department of Cell Systems and Anatomy, University of Texas Health at San Antonio, San Antonio, TX 78229, USA
| | - Rekha Kar
- Department of Cell Systems and Anatomy, University of Texas Health at San Antonio, San Antonio, TX 78229, USA.
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Carry PM, Nguyen AK, Merritt GR, Ciarallo C, Chatterjee D, Park J, Miller NH, Scott FA. Prevalence of Persistent Median Arteries in the Pediatric Population on Ultrasonography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:2235-2242. [PMID: 29480530 PMCID: PMC6109622 DOI: 10.1002/jum.14576] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 11/29/2017] [Accepted: 12/02/2017] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To use real-time ultrasonography to estimate the prevalence of persistent median arteries in a cohort of pediatric orthopedic patients. METHODS With Institutional Review Board approval, patients between the ages of 3 months and 19 years were recruited for this cross-sectional study. Variables of interest included demographics, underlying diagnoses, and the presence of a Doppler-confirmed median artery. Ultrasonographic examinations were performed on both upper extremities by a single investigator. Patient- and limb-level analyses were performed. A multivariable generalized logistic regression analysis was used to test the association between the prevalence of limb-specific persistent median arteries and age. A generalized estimating equation was used to adjust for the inclusion of multiple limbs from the same patient. RESULTS A total of 135 patients (270 limbs) were evaluated. The patient-specific prevalence rate (persistent median arteries present in 1 or both limbs) was 26.7%. Among these patients (n = 36), a persistent median artery was present bilaterally in 55.6% (n = 20). The limb-specific prevalence rate (proportion of limbs with a persistent median artery) was 20.7%. After adjusting for race, for every 1-year increase in age, the odds of a persistent median artery decreased by 4.4%. After adjusting for age, African Americans were significantly more likely to present with a persistent median artery (odds ratio, 3.78; 95% confidence interval, 1.25-11.48). CONCLUSIONS Ultrasonography can effectively visualize anatomic variants, such as persistent median arteries, in the pediatric population. The prevalence of persistent median arteries was higher than anticipated, especially among African American patients.
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Affiliation(s)
- Patrick M Carry
- Musculoskeletal Research Center, Children's Hospital Colorado, Aurora, Colorado, USA
- Department of Orthopedic Surgery, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Amy K Nguyen
- Musculoskeletal Research Center, Children's Hospital Colorado, Aurora, Colorado, USA
- Department of Orthopedic Surgery, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Glenn R Merritt
- Department of Anesthesiology, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Christopher Ciarallo
- Department of Anesthesiology, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Debnath Chatterjee
- Department of Anesthesiology, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Jung Park
- Department of Orthopedic Surgery, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Nancy H Miller
- Musculoskeletal Research Center, Children's Hospital Colorado, Aurora, Colorado, USA
- Department of Orthopedic Surgery, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Frank A Scott
- Musculoskeletal Research Center, Children's Hospital Colorado, Aurora, Colorado, USA
- Department of Orthopedic Surgery, Children's Hospital Colorado, Aurora, Colorado, USA
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Nejad DB, Azandeh S, Gholami MR, Gharravi AM, Zhaleh M. Superficial palmar arch with Persistent median artery. J ANAT SOC INDIA 2016. [DOI: 10.1016/j.jasi.2017.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Aragão JA, da Silva ACF, Anunciação CB, Reis FP. Median artery of the forearm in human fetuses in northeastern Brazil: anatomical study and review of the literature. Anat Sci Int 2016; 92:107-111. [PMID: 26747631 DOI: 10.1007/s12565-015-0322-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Accepted: 12/08/2015] [Indexed: 11/29/2022]
Abstract
A persistent median artery is a rare anomaly. It accompanies the median nerve along its course in the forearm and is of variable origin. It is associated with other local anatomical variations and may contribute significantly towards formation of the superficial palmar arch. In embryos, it is responsible mainly for the blood supply to the hand. The objective of this study was to research the frequency, type (forearm or palmar) and origin of the median artery in fetuses, correlating its presence with sex and body side. Red-colored latex was injected into 32 brachial arteries of human fetuses until its arrival in the hand could be seen. Twenty-four hours after the injection, the median arteries were dissected without the aid of optical instruments. Among the 32 forearms dissected, the median artery was present in 81.25 % (26) of the cases, and it was found more frequently in females and on the left side. Regarding origin, most of the median arteries originated in the common interosseous artery (38.5 %) and anterior interosseous artery (34.6 %). The mean length of the median arteries was 21.1 mm for the palmar type and 19.8 mm for the forearm type. The median artery has a high rate of persistence. It is important to be aware of this anatomical variation, since its presence may give rise to difficulties during routine surgical procedures on the wrist. Its presence may cause serious functional complications in the carpal tunnel, anterior interosseous nerve, round pronator syndromes, and ischemia of the hand.
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Affiliation(s)
- José Aderval Aragão
- Department of Morphology and the Postgraduate Physical Education and Applied Health Science Programs, Federal University of Sergipe (UFS), Avenida Marechal Rondon, s/n, Departamento de Morfologia, Jardim Rosa Elze, Cidade Universitária Professor José Aloísio de Campos - São Cristovão, Aracaju, Sergipe, Brazil. .,Medical School of Tiradentes University (UNIT), Av. Murilo Dantas 300, Farolândia, Aracaju, Sergipe, CEP: 49032490, Brazil. .,, Rua Aloisio Campos 500, Bairro Atalaia, Aracaju, Sergipe, CEP: 49035-020, Brazil.
| | - Ana Caroline Ferreira da Silva
- Medical School of Federal University of Sergipe (UFS), Avenida Marechal Rondon, s/n, Departamento de Morfologia, Jardim Rosa Elze, Cidade Universitária Professor José Aloísio de Campos - São Cristovão, Aracaju, Sergipe, Brazil
| | - Caio Barretto Anunciação
- Medical School of Federal University of Sergipe (UFS), Avenida Marechal Rondon, s/n, Departamento de Morfologia, Jardim Rosa Elze, Cidade Universitária Professor José Aloísio de Campos - São Cristovão, Aracaju, Sergipe, Brazil
| | - Francisco Prado Reis
- Medical School of Tiradentes University (UNIT), Av. Murilo Dantas 300, Farolândia, Aracaju, Sergipe, CEP: 49032490, Brazil
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Ata AM, Onat ŞŞ, Özçakar L. Ultrasound imaging for diagnosis and follow-up of persistent median artery thrombosis. Muscle Nerve 2015; 53:152-4. [PMID: 26348536 DOI: 10.1002/mus.24896] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 09/02/2015] [Accepted: 09/07/2015] [Indexed: 12/31/2022]
Affiliation(s)
- Ayşe Merve Ata
- Hacettepe University Medical School, Department of Physical and Rehabilitation Medicine, Ankara, Turkey
| | - Şule Şahin Onat
- Ankara Physical and Rehabilitation Medicine Training and Research Center, Ankara, Turkey
| | - Levent Özçakar
- Hacettepe University Medical School, Department of Physical and Rehabilitation Medicine, Ankara, Turkey
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Altinkaya N, Leblebici B. Prevalence of persistent median artery in carpal tunnel syndrome: sonographic assessment. Surg Radiol Anat 2015; 38:511-5. [DOI: 10.1007/s00276-015-1544-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 08/12/2015] [Indexed: 11/29/2022]
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Wong VW, Katz RD, Higgins JP. Interpretation of upper extremity arteriography: vascular anatomy and pathology [corrected]. Hand Clin 2015; 31:121-34. [PMID: 25455362 DOI: 10.1016/j.hcl.2014.09.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Understanding the utility and interpretation of upper extremity angiography is critical for the hand surgeon treating vaso-occlusive diseases of the hand. Although invasive and requiring the use of contrast dye, it remains the gold standard for imaging of the vascular system of the upper extremity. Angiography may detect numerous variants of the upper limb arterial system which may contribute to surgical pathology. Extensive vascular collateralization helps to maintain perfusion to the hand and facilitates reconstruction of the upper extremity. It is paramount to remember that angiography is a dynamic study and should represent a "flexible roadmap" for surgical reconstruction.
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Affiliation(s)
- Victor W Wong
- Curtis National Hand Center, MedStar Union Memorial Hospital, 3333 North Calvert Street #200, Baltimore, MD 21218, USA
| | - Ryan D Katz
- Curtis National Hand Center, MedStar Union Memorial Hospital, 3333 North Calvert Street #200, Baltimore, MD 21218, USA
| | - James P Higgins
- Curtis National Hand Center, MedStar Union Memorial Hospital, 3333 North Calvert Street #200, Baltimore, MD 21218, USA.
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CT angiography of the upper extremity arterial system: Part 1-Anatomy, technique, and use in trauma patients. AJR Am J Roentgenol 2013; 201:745-52. [PMID: 24059363 DOI: 10.2214/ajr.13.11207] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE In this article, we focus on the arterial anatomy of the upper extremities, the technical aspects of upper extremity CT angiography (CTA), and CTA use in trauma patients. CONCLUSION CTA using modern MDCT scanners has evolved into a highly accurate noninvasive diagnostic tool for the evaluation of patients with abnormalities of the upper extremity arterial system.
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Eid N, Ito Y, Otsuki Y. Median nerve decompression at lacertus tunnel: possible complications. Hand (N Y) 2013; 8:246-7. [PMID: 24426929 PMCID: PMC3653007 DOI: 10.1007/s11552-013-9525-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Nabil Eid
- Department of Anatomy and Cell Biology, Division of life sciences, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, 569-8686 Osaka Japan
| | - Yuko Ito
- Department of Anatomy and Cell Biology, Division of life sciences, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, 569-8686 Osaka Japan
| | - Yoshinori Otsuki
- Department of Anatomy and Cell Biology, Division of life sciences, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, 569-8686 Osaka Japan
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Singla RK, Kaur N, Dhiraj GS. Prevalence of the persistant median artery. J Clin Diagn Res 2013; 6:1454-7. [PMID: 23285428 DOI: 10.7860/jcdr/2012/4218.2531] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Accepted: 08/04/2012] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Neurovascular variations in the upper limb are common and they are well documented. An accurate knowledge of the normal and the variant anatomy of the median nerve and the median artery are important for clinical procedures and for vascular surgeries. The persistant median artery is one such anomaly which was seen in 6.6% (4) of the 60 upper limbs which were dissected in the present study, it being bilateral in one cadaver. MATERIAL AND METHODS The present study was conducted on 60 upper limbs of 30 cadavers at the Government Medical College, Amritsar, India. The whole course of the median nerve and the persistant median artery was exposed. RESULTS In all the 4 variant limbs, the persistent median artery originated from the anterior interrosseous artery and terminated in the incomplete mediano- ulnar type of the superficial palmar arch. In three upper limbs, the persistant median artery simply accompanied the median nerve upto the palm. But in the left upper limb of the cadaver with the bilateral variation, the artery penetrated and divided the nerve into two halves which joined to form a neural loop around the artery. Thereafter, the nerve and the artery followed the same course upto the palm. Such a penetration of the median nerve by the persistent median artery is extremely rare. Further, its ontogeny and clinical implications have been discussed in detail.
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Affiliation(s)
- Rajan Kumar Singla
- Associate Professor, Department of Anatomy, GMC Amritsar (Baba Farid University of Health Sciences and Research)
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Abstract
A 73-year-old woman developed an acute thrombosis of a persistent median artery following a Sisyphean struggle with a poorly fitted bedsheet. Ultrasound was able to diagnose the problem in a case where precise localization by electrodiagnostic testing was difficult.
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Affiliation(s)
- Francis O Walker
- Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, NC 27157-1078, USA.
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Feigl G, Petrac M, Pixner T, Ulz H, Mörth C, Dreu M. The superficial palmar arch and median artery as an example of misleading results due to a small number of investigated specimens or the use of different classifications. Ann Anat 2012; 194:389-95. [DOI: 10.1016/j.aanat.2011.10.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Revised: 10/14/2011] [Accepted: 10/16/2011] [Indexed: 10/14/2022]
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Persistent Median Artery (Palmar Type) and Median Nerve Block in the Forearm. Reg Anesth Pain Med 2012; 37:558-60. [DOI: 10.1097/aap.0b013e318260e458] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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