Abnormal branching pattern of the axillary artery

Abnormal Branching Pattern Of The Axillary Artery-A Case Study

Ramendra Raman Hasmatullah

A.Ghaffar Md Shafique

M Sc Medica l Anatomy (Students)

Department of Anatomy, H i -Tech Medica l Co l lege & Hosp i ta l ,

Hea l th Park , Rasu lgarh , Bhubaneshwar-751025Odisha

The axillary artery commences at the lateral border of the first rib, as a

continuationof the subclavian, and ends at the lower border of the axilla (i.e. the lower border

of teres major) to become the brachial artery. It is divided into three parts;.

Introduction

1st Part: Above the pectoralis minor; Superior Thoracic Artery.

2nd Part: Directly deep to the Pectoralis Minor;

Thoracoacromial Artery & Lateral Thoracic Artery. 3rd Part: Below the pectoralis minor; Anterior Circumflex Humeral Artery,

Posterior Circumflex Humeral Artery & Subscapular Artery.

During routine dissection of upper limb in a 45 years old male cadaver. We

observed the branching pattern of axillary artery was abnormal.

At dissection the following features are noted;

Case Report

The 1st part of the axillary artery gave only one branch Superior thoracic artery at the normal

level near the lower border of subclavias muscle and it supply the lymph node,muscle of the upper

portion of the thoracic wall The 2nd part of the axillary artery gave off two

branches I.Thoracoacromial artery arises from the 2nd

part of the axillary artery deep to the medial margin of the pectoralis minor muscle and run upward then pierces the clavipectoral facia and

divided in to four branches

Pectoral branch supply the pectoral musclesAcromial branch it goes toward the acromion

processes of the scapula and anastomosis of the another artery

Deltoid branch its run in the delto pectoral groove II. A large common trunk it is runs down medial

to the axillary vein Common trunk gives following branches

(a) Muscular branch (b) Lateral thoracic artery

(c) Sub scapular artery (d) Thoracodorsal artery

(e) Circumflex scapular artery (f) Posterior circumflex humeral artery

Lateral thoracic artery arises from the common trunk deep to the pectoralis minor muscle .Descend on the chest wall and supply the lower part of the front of

the chest wall .

Circumflex scapular artery passes through the triangular space and emerges out the posterior side

near the lateral border of scapula.Before passing through triangular space it give a

thoracodorsal branch.

Posterior circumflex humeral artery is a continuation of sabscapullar artery passes through the quadrangular space along with axillary nerve

and emerges out posterior side and round the surgical neck of the humerus below the deltoid

muscle.

Anterior circumflex humeral artery arises from the 3rd part of the axillary artery running laterally in front of the surgical neck of the humerus deep to

the coracobrachialis and biceps brachial it give one ascending branch in the intertubarcular sulcus to

supply the shoulder joint

Materials and methods

During routine dissection for undergraduate teaching. Between years

2008 to 2010 we observed unique anomalies in the right axilla of 45 years old male cadavers after dissection of 16 cadavers at the department of anatomy, Hi-Tech Medical College and Hospital,

Health Park, Bhubaneswar Orissa

discussionBranches of axillary artery vary.sometimes subscapular artery, circumflex humeral artery and arteria profunda brachii arise from Common trunk.But in our case lateral thoracic artery, thoracodorsal artery, subscapular artery, circumflex scapular

artery and posterior circumflex humeral artery arise common trunk.

Venieratos D and Lolis ED reported another case in which subscapular artery, anterior and posterior circumfl

ex humeral arteries, profunda brachii artery and ulnar collateral artery originated from a common trunk which

was named by them as common subscapular trunk2.

Occasionally the subscapular, circumflex humeral and profunda brachii arteries arise in common, branches of

the brachial plexus surround this common vessel instead of axillary artery. The posterior circumflex humeral artery may arise from the profunda brachii

artery and pass back below the teres major instead of passing through the quadrangular space (Johnson &

Ellis,2005).

Venieratos & Lolis (2001) shows common subscapular trunk gave origin to circumflex scapular,

thoracodorsal, anterior and posterior circumflex humeral, profunda brachii and ulnar collateral arteries.

In another report by Samuel et al. (2006) the third part of the axillary artery gave a common arterial trunk, which further gave anterior and

posterior circumflex humeral, subscapular, radial collateral, middle collateral and superior ulnar

collateral arteries with absence of profunda brachii artery.

Magden et al. (2007) observed "abnormal" branching pattern of the axillary artery and

unusual branch to the serratus anterior muscle, which originated directly from the first part of

the axillary artery as the first branch..

The lateral thoracic and thoracodorsal arteries arose together from the third part of the

axillary artery as "a lateral thoracicthoracodorsal"common trunk. The

superior thoracic artery was out of the position. The circumflex scapular artery

originated directly from the third part of the axillary artery.The subscapular artery was not

present.Our present report differs from this earlier

report in branching pattern as well as course of these branches.

Conclusion

The knowledge of variation of axillary artery is important for surgeons.Awarness about details and topographic anatomy of variation of the axillary artery may serve as a useful guide for both radiologist and vascular surgeons .it may help to prevent diagnostic error .during time of surgeries

for the lymph node in the axilla,and surgeries for the pactoral region presence of such anomalous branch ought to keep

in mind.

References

1.Johnson, D. & Ellis, H. Pectoral girdle and upper limb. In:Standring, S. Ed. Gray's Anatomy. 39th ed. Edinburgh,Elsevier, 2005. p. 8451. Tan CB, Tan CK. An unusual course and relations of the human

axillary artery.Singapore Med J 1994; 35: 263-264.2. Jurjus AR, Correa-De-Aruaujo R, Bohn RC.Bilateral double axillary artey: embryological basis and clinical implications. Clin Anat

1999; 12: 135-140.3. Hamilton WJ, Mossman HW. Cardiovascular system. In: Human

embryology. 4th ed.Baltimore: Williams and Wilkins, 1972: 271-290.4. De Garis CF, Swartley WB. The axillary artery in white and Negro

stocks. Am J Anat1928; 41: 3535. Cavdar S, Zeybek A, Bayramicli M. Rare variation of the axillary

artery. Clin Anat 2000; 13: 66-68.

Our spec ia l thanks To:

Dr. Ashok Nanda(Professor. & HOD)

Dr. Basan ta Pa r ida (Professor)

Dr. Gee ta S ingh(Professor)

Dr. Gee tan ja l i A ro ra ( Associate Professor)