Morphologic variations of the superficial palmar arc

The superficial palmar arc ensures the blood supply to the palm of the hand. It is formed by the ulnar artery and the superficial palmar branch of the radial artery (classic pattern), shows a distal convexity, from where three ordinary digital palmar arteries go out. It is located over the flexor muscles of the fingers, the lumbrical muscles, and the branches of the median and the ulnar nerves, under the protection of the palmar aponeurosis. PURPOSE: The fact of frequent anatomic variations attracted the interest in checking its incidence, improving the knowledge of the territory of the hand aiming clinical and surgical applications. The aim of this study is the observation of the morphology of the superficial palmar arc and the frequency of the variations regarding the contribution of the other arteries to its formation. METHODS: To carry out this work, 30 pieces of corpse, fixed in a watery solution of formaldehyde, were studied by the method of macroscopic dissection. The analyzed pieces were designed and photographs were taken, and the obtained results, statistically, applying the test of equality of proportions, had a level of trust of 95%. RESULTS: An amount of 100% showed the superficial palmar arc. From these, 18 cases (60%) showed anastomosis among the arteries that form the arc and 12 cases (40%) did not. Concerning about the arterial contribution for the arc formation, the following results were obtained: 11 cases (36,67%) were formed by the anastomosis of the ulnar artery with the superficial branch of the radial artery; 7 cases (23%) were formed by the ulnar artery only; 4 cases (13,33%) were formed by the ulnar artery and the superficial branch of the radial artery without anastomosis; 4 cases (13,33%) were formed by the anastomosis of the ulnar artery with the main artery of the thumb; 3 cases (10%) were formed by the anastomosis of the ulnar artery with the median artery of the forearm; 1 case (3,33%) was formed by the ulnar artery and the median artery without anastomosis. CONCLUSION: These results show the incidence of the classic pattern and variations of morphology and different types of contribution for the formation of the superficial palmar arc.

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AN ANATOMICAL STUDY OF SUPERFICIAL PALMAR ARCH IN WESTERN RAJASTHAN POPULATION

10.36106/ijar/1605193 ◽

2020 ◽

pp. 1-2

Author(s):

Leena Raichandani ◽

Dinesh Kumar ◽

Sushma Kushal Kataria

Keyword(s):

Radial Artery ◽

Anatomical Study ◽

Ulnar Artery ◽

Palmar Arch ◽

Variable Contribution ◽

Palmar Aponeurosis ◽

Median Artery ◽

Arteria Princeps Pollicis ◽

Arteria Radialis Indicis ◽

Distal Border

The supercial palmar arch is an anastomosis formed mainly by the Ulnar artery with variable contribution from branches of radial Artery. It passes medial to the hook of the hamate, then curves laterally to form an arch that is convex distally and level with a transverse line through the distal border of the fully extended pollicies base. About a third of the supercial palmar arches are formed by the ulnar artery alone; a further third are completed by the supercial palmar branch of the radial artery; and a third by the arteria radialis indicis, a branch of either arteria princeps pollicis or the median artery. The supercial palmar arch is covered by palmaris brevis and the palmar aponeurosis and it is supercial to exor digiti minimi, branches of the median nerve and the long exor tendons and lumbricals.

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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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Bilateral superficial median arteries

American Journal of Anatomy ◽

10.1017/s0021878299004690 ◽

1999 ◽

Vol 194 (3) ◽

pp. 475-477

Author(s):

TOSHIO NAKATANI ◽

ATSUSHI IZUMI ◽

SHIGENORI TANAKA

Keyword(s):

Clinical Importance ◽

Ulnar Artery ◽

Crossing Over ◽

Upper Limbs ◽

Superficial Palmar Arch ◽

Arterial Variation ◽

Palmar Arch ◽

Flexor Muscles ◽

Median Artery ◽

Superficial Ulnar Artery

A superficial artery may be present in the forearm, arising from the axillary, brachial or superficial brachial arteries and crossing over the origin of the flexor muscles of the forearm to reach the palm (Adachi, 1928; Bergman et al. 1988). When this superficial artery continues as the normal ulnar artery accompanying the ulnar nerve at the wrist, it is referred to as the superficial ulnar artery, with an incidence of ∼4%. When the artery passes below or superficial to the flexor retinaculum in the middle of the forearm, sometimes continuing to join the superficial palmar arch, it is called the superficial median artery, with an incidence of ∼1%. We have observed a relatively rare variation involving the presence of a superficial median artery in both upper limbs. We discuss the clinical importance and the developmental aspects of this arterial variation.

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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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Anomalies of radial and ulnar arteries

Jornal Vascular Brasileiro ◽

10.1590/1677-5449.011716 ◽

2017 ◽

Vol 16 (1) ◽

pp. 56-59 ◽

Cited By ~ 1

Author(s):

Rajani Singh ◽

Rashmi Malhotra ◽

Munish Wadhawan

Keyword(s):

Median Nerve ◽

Radial Artery ◽

Brachial Artery ◽

Ulnar Artery ◽

Medial Epicondyle ◽

Lateral Side ◽

Flexor Muscles ◽

Teres Major ◽

The Right ◽

Anomalous Formation

Abstract During dissection conducted in an anatomy department of the right upper limb of the cadaver of a 70-year-old male, both origin and course of the radial and ulnar arteries were found to be anomalous. After descending 5.5 cm from the lower border of the teres major, the brachial artery anomalously bifurcated into a radial artery medially and an ulnar artery laterally. In the arm, the ulnar artery lay lateral to the median nerve. It followed a normal course in the forearm. The radial artery was medial to the median nerve in the arm and then, at the level of the medial epicondyle, it crossed from the medial to the lateral side of the forearm, superficial to the flexor muscles. The course of the radial artery was superficial and tortuous throughout the arm and forearm. The variations of radial and ulnar arteries described above were associated with anomalous formation and course of the median nerve in the arm. Knowledge of neurovascular anomalies are important for vascular surgeons and radiologists.

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Multiple arterial anomalies in upper limb

Kathmandu University Medical Journal ◽

10.3126/kumj.v7i3.2740 ◽

1970 ◽

Vol 7 (3) ◽

pp. 293-297 ◽

Cited By ~ 2

Author(s):

P Baral ◽

P Vijayabhaskar ◽

S Roy ◽

S Kumar ◽

S Ghimire ◽

...

Keyword(s):

Radial Artery ◽

Upper Limb ◽

Axillary Artery ◽

Ulnar Artery ◽

Common Trunk ◽

Palmar Arch ◽

Thoracoacromial Artery ◽

The Third ◽

Flexor Muscles ◽

Interosseous Artery

An isolated neurovascular variation is common but multiple vascular anomalies on same upper limb is a very rare case. We observed an unusual variations in right upper limb during routine dissection of a Nepali cadaver. The variations were observed in Axilla, Forearm and Palm. In axilla, first part of axillary artery did not give any branch, the second part of axillary artery gave off only two branches - (a) thoracoacromial artery and (b) a large common trunk which later gave off lateral thoracic, thoracodorsal, subscapular, posterior circumflex scapular and then continued as posterior circumfl ex humeral artery. The third part of axillary artery gave off only anterior circumflex humeral artery. In forearm, the ulnar artery runs downward superficial to flexor muscles. Here, radial artery gave off common interosseous artery. In palm radial artery did not give any contribution to superficial palmar arch which is solely formed by the continuation of ulnar artery. This type of anomalies are very rare and is not reported in Nepalese cadaver at all. These anomalies are described in detail and their clinical relevance is highlighted. Key words: Axillary artery; Brachial artery; Radial artery; Ulnar artery; Palmar arch; Variations DOI: 10.3126/kumj.v7i3.2740 Kathmandu University Medical Journal (2009) Vol.7, No.3 Issue 27, 293-297

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Assessment of the Radial Artery and Hand Circulation by Computed Tomography Angiography: A Pilot Study

The Heart Surgery Forum ◽

10.1532/hsf98.20041042 ◽

2005 ◽

Vol 8 (1) ◽

pp. 28 ◽

Cited By ~ 13

Author(s):

Omer Faruk Dogan ◽

Musturay Karcaaltincaba ◽

Umit Duman ◽

Deniz Akata ◽

Aytekin Besim ◽

...

Keyword(s):

Diabetes Mellitus ◽

Coronary Artery ◽

Coronary Artery Bypass ◽

Radial Artery ◽

Anatomic Variation ◽

Artery Bypass ◽

Bypass Graft ◽

Preoperative Imaging ◽

Median Artery ◽

Test Result

Objectives: The radial artery (RA) is increasingly being used as a coronary bypass graft. Results of a previous study using Doppler ultrasound and histopathologic examinations indicated that the RA has a higher incidence of preexisting intimal hyperplasia, medial calcification, and atherosclerosis than the internal thoracic artery. The aims of this study were to evaluate the use of computed tomographic angiography (CTA) to display hand collateral circulation, to define the criteria for an abnormal CTA test result, and to demonstrate usefulness of CTA as an alternative to conventional angiography for evaluation of the radial artery. Materials and Methods: Sixteen patients scheduled for coronary artery bypass grafting entered this study. We performed 32 examinations of forearm and hand arterial anatomy in these patients. CTA was performed in patients with a normal Allen test result, except 1 patient who had a persistent median artery. Soft tissue density forehand roentgenography was performed in all patients before the CTA evaluation. There was no selection of patients in relation to patient characteristics. As a risk factor for radial artery calcification, 6 of the patients had diabetes mellitus, 6 had aortofemoral occlusive disease, and 4 had a history of smoking. Results: Bilateral forearm arteries were visualized in all patients. Severe RA calcification was found in 1 patient, and distal occlusion was found in another patient. Focal RA calcification was noted in 2 patients. In the remaining patients no radial artery calcification or occlusion was noted. Anatomic variation of the upper limb arteries was shown in 2 patients; these variations were persistent median artery with absence of the radial and ulnar arteries and high bifurcation of the radial artery from the brachial artery. Conclusion: CTA is useful and safe for detection of radial artery calcific disease and assessment of the forehand circulation and its anatomic variations. Preoperative imaging of the RA is a means to avoid unnecessary forearm exploration or inadvertent use of a diseased conduit in coronary artery bypass candidates with multiple risk factors such as diabetes mellitus.

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Can Ulnar Artery Velocity Changes Be Used as a Preoperative Screening Tool for Radial Artery Grafting in Coronary Artery Bypass?

Annals of Vascular Surgery ◽

10.1007/s10016-001-0248-8 ◽

2003 ◽

Vol 17 (3) ◽

pp. 253-259 ◽

Cited By ~ 8

Author(s):

V.V. Sullivan ◽

C. Higgenbotham ◽

C.J. Shanley ◽

J. Fowler ◽

R.M. Lampman ◽

...

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass ◽

Radial Artery ◽

Screening Tool ◽

Artery Bypass ◽

Ulnar Artery ◽

Preoperative Screening ◽

Velocity Changes

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Common ground, different path: Ulnar artery access for interventional neurovascular procedures

Interventional Neuroradiology ◽

10.1177/15910199211040280 ◽

2021 ◽

pp. 159101992110402

Author(s):

Muhammad U. Manzoor ◽

Ibrahim A. Almulhim ◽

Abdullah A. Alrashed ◽

Abdulrahman Y. Alturki ◽

Fatimah A. Alghabban ◽

...

Keyword(s):

Radial Artery ◽

Interventional Procedures ◽

Common Ground ◽

Interventional Neuroradiology ◽

Ulnar Artery ◽

Patient Comfort ◽

Access Site Complication ◽

Patient Demographics ◽

Wide Range ◽

Feasible Option

Background Recently, radial artery access has gained popularity for interventional neurovascular procedures due to patient comfort and fewer complications. However, there are instances where the radial artery approach is not feasible. In such cases, trans-ulnar artery access (TUA) can offer an alternate route. There is limited data regarding neuro-interventional procedures performed via this approach. This study aims to evaluate the feasibility and safety of trans-ulnar approach for a wide range of interventional neurovascular procedures. Materials and methods The data for all patients who underwent ulnar artery access for diagnostic or interventional neuroradiology procedures was retrospectively collected between September 2020 and March 2021. Patient demographics, procedural details, procedure success, and complications were recorded. Results During the study period, 23 patients underwent 24 trans-ulnar approach procedures. The mean age of patients was 50.1 ± 14.2 years. Fourteen diagnostic cerebral angiograms and ten interventional procedures were performed. All procedures were successfully completed via trans-ulnar approach without a switch to alternate access. No major access site complication was observed. Conclusion Ulnar artery access is a safe and feasible option for neurovascular procedures. It can be effectively utilized for diagnostic cerebral angiography and a wide range of interventional procedures.

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