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)
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