Successful nonoperative management of mycotic radial artery pseudoaneurysm in patient with absent superficial palmar arch

Background: The complex and variable pattern of the arterial arcades of the palm form an interesting area of study anatomically and surgically. In the present study arches were classified into complete and incomplete types, the complete type being the most prominent in 88.6% of the palms. Among the complete type, arch formed by ulnar artery alone supplying the thumb and index finger was found in majority of the specimens (50%). The classical or standard superficial palmar arch formed by the superficial palmar branch of radial and ulnar arteries was found in only 28.5%. Different patterns of the arterial arcades of the superficial palmar arch are normally encountered during routine anatomical dissections of the palm which needs to be emphasized and highlighted for a desired surgical out come during microvascular reconstructive surgeries of the palm and during radial artery cannulation. Context: With technological advancements in microsurgical procedures of the hand, fields of anatomical interest like the classification of arterial arcades of the palm, now becomes essential for operating vascular surgeons for a desired surgical outcome Purpose of the study: The present study was taken up to analyze and document varying patterns of the arterial arcades of the superficial palmar arch. Methods and Material: the study was conducted by dissecting 70 randomly obtained formalin fixed cadaver palms. Results: In the present study arches were classified into complete and incomplete types, the complete type being the most prominent in 88.6% of the palms. Among the complete type, arch formed by ulnar artery alone supplying the thumb and index finger was found in majority of the specimens (50%). The classical or standard superficial palmar arch formed by the superficial palmar branch of radial and ulnar arteries was found in only 28.5%. Out of the 70 hands, incomplete arches were found only in 8 hands with an incidence of 11.4%. Conclusion: Knowledge of arterial pattern of the hand is very important to vascular and reconstructive surgeons for effective treatment of injuries of the hand. Such a knowledge of the disposition of the arterial arcades of the palm also enables cardio-vascular surgeons to plan and modify surgical procedures such as radial artery harvesting, cannulation and in preventing the ischemia of hands in such procedures. KEY WORDS: Superficial palmar arch, Arterial arcades, Complete arch, Incomplete arch.

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VARIATIONS OF THE SUPERFICIAL PALMAR ARCH: A CLINICO-ANATOMICAL CONSIDERATION

International Journal of Anatomy and Research ◽

10.16965/ijar.2020.231 ◽

2020 ◽

Vol 8 (4.2) ◽

pp. 7817-7822

Author(s):

Pooja Dawani ◽

◽

Anita Mahajan ◽

Sabita Mishra ◽

Neelam Vasudeva ◽

...

Keyword(s):

Radial Artery ◽

Blood Supply ◽

Myocardial Revascularization ◽

Ulnar Artery ◽

Vital Role ◽

Superficial Palmar Arch ◽

Palmar Arch ◽

Human Cadavers ◽

Median Artery ◽

Digital Caliper

Introduction: The superficial palmar arch plays a vital role in the blood supply to the hand. The knowledge of variations in the pattern of superficial palmar arch and its branches, and caliber of these arteries, has become more important for surgeons in reconstructive hand surgeries and radial artery harvesting for myocardial revascularization. The aim of this study was to observe the variations and measure the diameter of contributing arteries of the arches. Materials and methods: In the present study, thirty hands from formalin fixed adult human cadavers were dissected. Normal pattern as well as variations in the arteries contributing to the arch, completeness of arch, and the branching pattern were observed and noted. With the help of a digital caliper, the diameters of ulnar and radial arteries and median artery were taken at the level of the wrist and statistical analysis of the results was done. Results: It was observed that in 96.7 % cases, the superficial palmar arch was complete where there was anastomosis between the arteries forming the arch. In 3.3% cases, the arch was incomplete. The complete arch was divided into radioulnar (36.7%), ulnar (56.7%) and medianoulnar (3.3%) types. The diameter of superficial palmar branch of radial artery was found to be significantly less than the diameter of ulnar artery. (p=0.003). Conclusion: The data obtained on variations and morphometry of superficial palmar arches will certainly be useful in planning and choosing appropriate and safe surgical procedures to prevent inadvertent outcome. KEY WORDS: Palmar arch, blood supply, Hand, radial artery, myocardial revascularization.

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Palmar Arch: Anatomical And Surgical Correlation in Trauma

International Journal of Medical and Surgical Sciences ◽

10.32457/ijmss.2016.029 ◽

2018 ◽

Vol 3 (3) ◽

pp. 951-958

Author(s):

Agustín Algieri ◽

Rubén Algieri ◽

Homero Bianchi ◽

María Ferrante ◽

Carolina Brofman

Keyword(s):

Radial Artery ◽

Ulnar Artery ◽

Anatomical Variations ◽

Morphometric Study ◽

Superficial Palmar Arch ◽

Palmar Arch ◽

Complete Section ◽

Starting Point ◽

Classic Pattern ◽

Median Artery

The irrigation of the palm is provided by arterial arches (shallow and deep) that are made more frequently by the ulnar or radial arteries described as setting a classic pattern. Anatomical variations are described in shaping both arches, most often in the superficial palmar arch; may be the same complete or incomplete. The objective of this work is the anatomical description of the palmar arches, their different patterns and variations in conformation, and their clinical and surgical implications. A descriptive, observational and morphometric study of the arteries involved in the formation of the palmar arches was done in the Faculty of Medicine, University of Buenos Aires. One hundred1(00) cadaveric preparations fixed in formalin solution, of the Third Chair of Anatomy were used. A retrospective analysis of cases with lesions / s artery / main / s that make the palmar arches in the Emergency Hospital of Moron, between 2015-2016 s was also carried out. Most frequently the radial artery forms the deep palmar arch with the deep palmar branch of the ulnar artery. Superficial palmar arch is the most variable. It was complete in 56 % and the most common presentation (83 %) is one that is formed by the anastomosis of the ulnar artery and the superficial palmar branch of the radial artery. The rest of the anastomosis are between ulnar artery and median artery (9%), between deep branch of radial artery and ulnar artery (5 %); triple anastomosis between ulnar artery, median artery and superficial palmar branch of the radial artery (2 %), and anastomosis between the median artery and superficial palmar branch of the radial artery without participation of the ulnar artery (1 %). The rest of the sample (44 %) can be termed as incomplete. The B1a and B1b subtypes were the most found. Two cases, one entire section of the radial artery at the wrist and the other with complete section of ulnar artery with involvement of the ulnar nerve are described. It is essential to a proper understanding of the palmar arches for a suitable surgical approach to hand. The importance of the presence or absence, as well as different variations of palmar arterial arch lies in its clinical application as surgical starting point in the treatment of trauma and other diseases in which there is engagement of arteries.

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Study of contributing arteries to superficial palmar arch formation

Indian Journal of Clinical Anatomy and Physiology ◽

10.18231/j.ijcap.2021.061 ◽

2021 ◽

Vol 8 (4) ◽

pp. 280-283

Author(s):

Bangale Sridevi P

Keyword(s):

Radial Artery ◽

Surgical Procedures ◽

Vascular Graft ◽

Ulnar Artery ◽

Upper Limbs ◽

Superficial Palmar Arch ◽

Palmar Arch ◽

Superficial Branch ◽

Median Artery

The superficial palmar arch (SPA) is formed predominantly by the ulnar artery with a contribution from the superficial palmar branch of the radial artery.: To study contributing arteries in superficial palmar arch formation and variations in its formation.: Study comprised of 30 upper limbs from 15 cadavers. Palmar arches in them were dissected following classical incisions and dissection procedures of Cunninghams’ manual.: SPA was formed by superficial branch of ulnar artery only in 13.33% specimens, by superficial branch of both ulnar and radial artery in 70% specimens, by superficial branch of ulnar and persistent median artery in 13.33% specimens and was formed by superficial branches of ulnar and radial arteries with persistent median artery in 3.33% specimens. SPA was complete in 80% and was incomplete in 20% specimens.: The arch formation is highly variable. Knowledge of contribution to the SPA will be helpful to the reconstructive hand surgical procedures such as arterial repairs, vascular graft applications and re-implantations.

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Ischemia of the Hand Secondary to Radial Artery Thrombosis: A Report of Three Cases

Canadian Journal of Plastic Surgery ◽

10.1177/229255030301100308 ◽

2003 ◽

Vol 11 (3) ◽

pp. 145-148 ◽

Cited By ~ 1

Author(s):

Sachin A Chitte ◽

Karen Veltri ◽

Achilleas Thoma

Keyword(s):

Radial Artery ◽

Saphenous Vein ◽

Arterial Thrombosis ◽

Saphenous Vein Graft ◽

Superficial Palmar Arch ◽

Spontaneous Thrombosis ◽

Palmar Arch ◽

Artery Thrombosis ◽

Common Etiology ◽

Hypothenar Eminence

Upper extremity arterial thrombosis, though rare, is more prevalent on the ulnar side of the circulation, with the most common etiology being repetitive blunt trauma to the hypothenar eminence. Radial artery thrombosis is even more rare and when it does occur, is associated most often with iatrogenic cannulation, producing subsequent thrombi and emboli. Three cases of spontaneous thrombosis of the radial artery extending to the superficial palmar arch and the princeps pollicis artery are presented here. Two patients underwent thrombectomies and one underwent excision of the thrombosed segment and reconstruction with a reversed saphenous vein graft. The etiology of the thrombus was consistent with cancer in two cases and trauma in one.

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Congenital Bilateral Absence of the Radial Artery: A Very Rare Variation in Humans - Phylogenetic and Ontogenetic Aspects

Cells Tissues Organs ◽

10.1159/000450575 ◽

2016 ◽

Vol 203 (3) ◽

pp. 194-202 ◽

Cited By ~ 1

Author(s):

Bettina Pretterklieber ◽

Gerda Martschini ◽

Michael L. Pretterklieber

Keyword(s):

Radial Artery ◽

Wrist Joint ◽

Anatomic Variation ◽

Ulnar Artery ◽

Caucasian Woman ◽

Superficial Palmar Arch ◽

Palmar Arch ◽

Arterial Blood ◽

Bilateral Absence ◽

The Right

In an 80-year-old Caucasian woman, both radial arteries were found to be replaced by an enlarged anterior interosseous artery. Additionally, the right forearm revealed a persistent median artery which formed the superficial palmar arch together with the ulnar artery. In both hands, the replaced radial artery was connected only to the deep but not the superficial palmar arch. In clinical practice, lack of an arterial pulse on the radial aspect of the wrist joint may indicate the presence of this anatomic variation. In this case, arterial blood sample collections, application of contrast media, invasive measurements of blood pressure, and several angiographic interventions cannot be performed via the radial artery. As this is the fourth reported case since 1830, bilateral aplasia of the radial artery appears to be an exceptional variation in humans. Thus, the phylo- and ontogenetic aspects of this anomaly are discussed.

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