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 Table of Contents  
CASE REPORT
Year : 2016  |  Volume : 5  |  Issue : 1  |  Page : 39-41

A rare variation in the branching pattern of axillary artery


1 Department of Anatomy, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
2 Department of Orthopaedics, Patna Medical College Hospital, Patna, Bihar, India

Date of Web Publication23-May-2016

Correspondence Address:
Md Jawed Akhtar
Department of Anatomy, Indira Gandhi Institute of Medical Sciences, Patna - 800 014, Bihar
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2278-0521.182865

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  Abstract 

An unusual variation of the axillary artery was reported in the right side of a 63-year-old female cadaver during routine dissection classes. It was observed that the first part of the axillary artery gave origin to the superior thoracic artery as usual and the second part gave thoracoacromial artery, which showed the normal course and branching pattern. In addition to this branch, the second part also gave a large common trunk from which lateral thoracic artery and subscapular artery arose. The subscapular artery was divided into circumflex scapular and thoracodorsal arteries. The circumflex scapular artery after passing through the upper triangular space of axilla emerged out near the lateral border of scapula on the posterior aspect. The thoracodorsal artery was seen as continuation of the subscapular artery after giving the branch circumflex scapular artery, lies posterior to the lateral thoracic artery. It gave muscular branches to teres major and serratus anterior. The third part of the axillary artery gave anterior and posterior circumflex humeral artery only. The detailed knowledge about anatomy of normal as well as variant axillary artery is very helpful to clinicians in operative and invasive procedures around pectoral and axillary regions, especially in the field of vascular surgeries. This is also useful to radiologists in different Doppler and contrast imaging study of the vessels.

Keywords: Axillary artery, lateral thoracic artery, subscapular artery


How to cite this article:
Akhtar MJ, Rahman S, Kumar B, Kumar V. A rare variation in the branching pattern of axillary artery. Saudi J Health Sci 2016;5:39-41

How to cite this URL:
Akhtar MJ, Rahman S, Kumar B, Kumar V. A rare variation in the branching pattern of axillary artery. Saudi J Health Sci [serial online] 2016 [cited 2017 Nov 19];5:39-41. Available from: http://www.saudijhealthsci.org/text.asp?2016/5/1/39/182865


  Introduction Top


The third part of subclavian artery continues as axillary artery at the outer border of the first rib which extends up to the lower border of teres major muscle, where it becomes brachial artery. The position of the arm affects the course of the artery. The artery becomes straight when the arm is raised at right angles to the body; the artery becomes concave upward when the arm is raised above the head, and its becomes concave downward when the arm is held beside the body. [1] During its course, pectoralis minor divides it into three parts. The portion of the artery which is proximal to pectoralis minor is the first part, posterior to it is the second part, and distal to it is the third part. In its entire course, it usually gives off six branches. The first part gives only one named superior thoracic artery; the second part gives two branches namely thoracoacromial and lateral thoracic artery while the third part finally gives three branches, i.e., subscapular, which is the largest branch of the axillary artery, anterior circumflex humeral artery, and posterior circumflex humeral artery. These all branches of the axillary artery along with branches of subclavian artery form an extensive anastomosis around dorsal surface of the scapula. The detailed knowledge about anatomy of normal as well as variant axillary artery is very helpful to clinicians in operative and invasive procedures around pectoral and axillary regions, especially in the field of vascular surgeries. This is also useful to radiologists in different Doppler and contrast imaging study of the vessels. We found a unique variant of branching pattern of axillary artery during routine dissection classes, which has been not reported till now in literature.


  Case report Top


During our routine dissection classes of the 1 st year MBBS students in the Department of Anatomy of Indira Gandhi Institute of Medical Sciences, Patna (Bihar, India), we found a unique unilateral variant of branching pattern of axillary artery in the right axilla of a 63-year-old female cadaver. The history of the cadaver and its cause of death were not known. This case was photographed by HTC Desire 816 mobile phone and findings were noted. It was observed that the first part of axillary artery gave origin to the superior thoracic artery as described in our standard textbooks and the second part gave thoracoacromial artery, which showed the normal course and branching pattern. In addition to this branch, the second part also gave a large common trunk from which following arteries arose: (a) Lateral thoracic artery and (b) subscapular artery which was again divided into circumflex scapular and thoracodorsal arteries. The circumflex scapular artery after passing through the upper triangular space of axilla emerged out near the lateral border of the scapula on the posterior aspect. The thoracodorsal artery was seen as continuation of the subscapular artery after giving the branch circumflex scapular artery, lies posterior to the lateral thoracic artery. It gave muscular branches to teres major and serratus anterior [Figure 1]. The third part of axillary artery gave anterior and posterior circumflex humeral artery only [Figure 2]. The posterior circumflex humeral artery entered in the quadrangular space along with the axillary nerve. The branching pattern of the axillary artery was absolutely normal in left axilla.
Figure 1: Branches of the first and second parts of the axillary artery on the right side (AA: Axillary artery; TAA: Thoracoacromial artery; STA: Superior thoracic artery; CT: Common trunk; LTA: Lateral thoracic artery; SSA: Subscapular artery; TDA: Thoracodorsal artery; CSA: Circumflex scapular artery; MB: Muscular branch; PM: Pectoralis minor; MCN: Musculocutaneous nerve; BA: Brachial artery; MN: Median nerve)

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Figure 2: Branches of the third part of the axillary artery on the right side (AA: Axillary artery; ACHA: Anterior circumflex humeral artery; PCHA: Anterior circumflex humeral artery; TAA: Thoracoacromial artery; STA: Superior thoracic artery; CT: Common trunk; LTA: Lateral thoracic artery; SSA: Subscapular artery; TDA: Thoracodorsal artery; CSA: Circumflex scapular artery; MB: Muscular branch; MCN: Musculocutaneous nerve; RN: Radial nerve; MN: Median nerve; BA: Brachial artery)

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  Discussion Top


The anatomical variation of branching pattern of major arteries of the upper extremities is not uncommon in literature. Various types of variation in branching pattern of axillary artery are reported by different authors from different parts of the world. However, the present case is unique and still it is not documented in the literature. Sarkar et al. [2] reported that the second part of axillary artery gave only one branch, i.e., thoracoacromial artery while the third part gave anterior circumflex humeral artery and a common trunk from where lateral thoracic artery, subscapular artery, and posterior circumflex humeral artery arose. Lateral thoracic artery was the largest branch of axillary artery in that case. Saeed et al. [3] also observed that the second part of axillary artery gave a bilateral thoracohumeral trunk. In 1.9% of cases, these trunks again divided into lateral thoracic artery, circumflex humeral, subscapular as well as thoracodorsal arteries. Swamy et al. [4] reported a case in which the right subscapular artery was a branch of the second part of the axillary artery which finally gave origin to lateral thoracic artery as well as posterior circumflex humeral artery while the third part gave rise to anterior circumflex humeral artery along with ulnar artery of high origin. Ramesh et al. [5] reported that a common trunk arose from the third part of the axillary artery of the left side which gave origin to subscapular artery, anterior and posterior circumflex humeral artery, profunda brachii artery, and ulnar collateral artery. The first and second parts of axillary artery were normal. Cavdar et al. [6] observed that the third part of axillary artery gave two branches named superficial and deep brachial artery. The anterior and posterior circumflex humeral artery, subscapular artery, and profunda brachii artery arose from deep brachial artery while the superficial brachial artery which was larger in caliber than deep finally divides into ulnar and radial arteries in cubital fossa. There was no branch arose from superficial brachial artery in the arm. Any defect in the embryonic development of the vascular plexus of upper limb bud may be a cause of difference in branching pattern of the axillary artery. The lateral branch of the seventh intersegmental artery gave rise to axial artery of which proximal part transformed into the axillary and brachial artery. These different types of variations may occur due to arrest at any developmental stage of vessels of the upper limb such as regression, retention, or reappearance of new blood vessels. [7] Injuries of brachial plexus are very common at present, which requires urgent exploration of axilla and repair. [6] During surgeries around pectoral and axillary regions, knowledge about these variations plays a significant role in reduction of uneventful complications. During coronary bypass grafting as well as other reconstructive surgeries of the axillary artery after trauma, surgeons use different microvascular grafts from branches of upper extremities arteries as well as medial arm skin flap. [8] Thus, both the normal and different variations regarding axillary artery should be precisely known by clinicians for accurate diagnostic purposes and surgical interventions.

Financial support and sponsorship

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Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Johnson D. Pectoral girdle, shoulder region and axilla. In: Standring S, editor. Gray′s Anatomy: The Anatomical Basis of Clinical Practices. 40 th ed. New York, USA: Elsevier, Churchill Livingstone; 2008. p. 791-822.  Back to cited text no. 1
    
2.
Sarkar S, Kundu B, Bose A, Saha PK. Variation of branching pattern of axillary artery. Int J Anat Var 2014;7:27-9.  Back to cited text no. 2
    
3.
Saeed M, Rufai AA, Elsayed SE, Sadiq MS. Variations in the subclavian-axillary arterial system. Saudi Med J 2002;23:206-12.  Back to cited text no. 3
    
4.
Swamy R, Rao M, Kumar N, Sirasanagandla S, Nelluri V. Unusual branching pattern of axillary artery associated with the high origin of ulnar artery. Ann Med Health Sci Res 2013;3:265-7.  Back to cited text no. 4
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5.
Ramesh RT, Shetty P, Suresh R. Abnormal branching pattern of the axillary artery and its clinical significance. Int J Morphol 2008;26:389-92.  Back to cited text no. 5
    
6.
Cavdar S, Zeybek A, Bayramiçli M. Rare variation of the axillary artery. Clin Anat 2000;13:66-8.  Back to cited text no. 6
    
7.
Hamilton WJ, Mossman HW. Cardiovascular system. In: Human Embryology. 4 th ed. Baltimore: Williams and Wilkins; 1972. p. 271-90.  Back to cited text no. 7
    
8.
Karamürsel S, Bagdatli D, Demir Z, Tüccar E, Celebioglu S. Use of medial arm skin as a free flap. Plast Reconstr Surg 2005;115:2025-31.  Back to cited text no. 8
    


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