Median artery of the forearm in human fetuses in northeastern Brazil: anatomical study and review of the literature

Abstract

A persistent median artery is a rare anomaly. It accompanies the median nerve along its course in the forearm and is of variable origin. It is associated with other local anatomical variations and may contribute significantly towards formation of the superficial palmar arch. In embryos, it is responsible mainly for the blood supply to the hand. The objective of this study was to research the frequency, type (forearm or palmar) and origin of the median artery in fetuses, correlating its presence with sex and body side. Red-colored latex was injected into 32 brachial arteries of human fetuses until its arrival in the hand could be seen. Twenty-four hours after the injection, the median arteries were dissected without the aid of optical instruments. Among the 32 forearms dissected, the median artery was present in 81.25 % (26) of the cases, and it was found more frequently in females and on the left side. Regarding origin, most of the median arteries originated in the common interosseous artery (38.5 %) and anterior interosseous artery (34.6 %). The mean length of the median arteries was 21.1 mm for the palmar type and 19.8 mm for the forearm type. The median artery has a high rate of persistence. It is important to be aware of this anatomical variation, since its presence may give rise to difficulties during routine surgical procedures on the wrist. Its presence may cause serious functional complications in the carpal tunnel, anterior interosseous nerve, round pronator syndromes, and ischemia of the hand.

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References

  1. Bergman RA, Thompson SA, Afifi AK, Saadeh FA (1988) Compendium of human anatomic variations. Urban and Schwarzenberg, Baltimore-Munich. [cited 2015 May 25]. http://www.anatomyatlases.org/AnatomicVariants/Cardiovascular/Text/Arteries/Median.shtml

  2. Claassen H, Schmitt O, Wree A (2008) Large patent median arteries and their relation to the superficial palmar arch with respect to history, size consideration and clinic consequences. Surg Radiol Anat 30:57–63

    Article  PubMed  Google Scholar 

  3. Constantino ER, de Paula RC, Rodrigues MR, Fernandes RM (2009) Artéria mediana persistente: abordagem anatômica e implicações clínicas. Acta Sci Med 2:58–63

    Google Scholar 

  4. D’Costa S, Narayana K, Narayan P, Nayak SR, Madhan SJ (2006) Occurrence and fate of palmar type of median artery. ANZ J Surg 76:484–487

    Article  PubMed  Google Scholar 

  5. Eid N, Ito Y, Shibata MA, Otsuki Y (2011) Persistent median artery cadaveric study and review of the literature. Clin Anat 24:627–633

    CAS  Article  PubMed  Google Scholar 

  6. Henneberg M, George BJ (1992a) A further study of the high incidence of the median artery of the forearm in Southern Africa. J Anat 181:151–154

    PubMed  PubMed Central  Google Scholar 

  7. Henneberg M, George BJ (1992b) High incidence of the median artery of the forearm in a sample of recent southern African cadavers. J Anat 180:185–188

    PubMed  PubMed Central  Google Scholar 

  8. Henneberg M, George BJ (1996) High frequency of the median artery of the forearm in South African newborns and infants. S Afr Med J 86:175–176

    PubMed  Google Scholar 

  9. Jones NF, Ming NL (1988) Persistent median artery as a cause of pronator syndrome. J Hand Surg Am 13:728–732

    CAS  Article  PubMed  Google Scholar 

  10. Kopuz C, Gülman B, Bariş S (1995) Persistent median artery: an anatomical study in neonatal and adult cadavers. Kaibogaku Zasshi 70:577–580

    CAS  PubMed  Google Scholar 

  11. Kopuz C, Baris S, Gulman B (1997) A further morphological study of the persistent median artery in neonatal cadavers. Surg Radiol Anat 19:403–406

    CAS  Article  PubMed  Google Scholar 

  12. Lindley SG, Kleinert JM (2003) Prevalence of anatomic variations encountered in elective carpal tunnel release. J Hand Surg 28A:849–855

    Article  Google Scholar 

  13. Maher WP (1990) Palmar-digital arterial networks in fifty pairs of human fetal hands: arteriographic models for clinical considerations. Am J Anat 187:201–210

    CAS  Article  PubMed  Google Scholar 

  14. Muratore T, Ozer K (2011) Persistent median artery in a pediatric trauma patient: case report. J Hand Surg 36A:658–660

    Article  Google Scholar 

  15. Natsis K, Iordache G, Gigis I, Kyriazidou A, Lazaridis N, Noussios G, Paraskevas G (2009) Persistent median artery in the carpal tunnel: anatomy, embryology, clinical significance, and review of the literature. Folia Morphol (Warsz) 68:193–200

    CAS  Google Scholar 

  16. Nayak SR, Krishnamurthy A, Kumar SJM, Prabhu LV, Potu BK, D’Costa S, Ranade AV (2010) Palmar type of median artery as a source of superficial palmar arch: a cadaveric study with its clinical significance. HAND 5:31–36

    Article  PubMed  Google Scholar 

  17. Ramanathan L, Nayak SR, Vinay KV, Krishnamurthy A, Prabhu LV (2009) Co- existence of superficial brachio-ulno-radial arterial pattern and persistent median artery. Indian J Plast Surg 42:112–114

    Article  PubMed  PubMed Central  Google Scholar 

  18. Rodríguez-Baeza A, Nebot J, Ferreira B, Reina F, Pérez J, Sañudo JR, Roig M (1995) An anatomical study and ontogenetic explanation of 23 cases with variations in the main pattern of the human brachio-antebrachial arteries. J Anat 187:473–479

    PubMed  PubMed Central  Google Scholar 

  19. Rodríguez-Niedenführ M, Sañudo JR, Vázquez T, Nearn L, Logan B, Parkin I (1999) Median artery revisited. J Anat 195:57–63

    Article  PubMed  PubMed Central  Google Scholar 

  20. Rodríguez-Niedenführ M, Burton GJ, Deu J, Sañudo JR (2001) Development of the arterial pattern in the upper limb of staged human embryos: normal development and anatomic variations. J Anat 199:407–417

    Article  PubMed  PubMed Central  Google Scholar 

  21. Rodríguez-Niedenführ M, Vázquez T, Parkin IG, Sañudo JR (2003) Arterial patterns of the human upper limb: update of anatomical variations and embryological development. Eur J Anat Suppl 7:21–28

    Google Scholar 

  22. Singer E (1933) Embryological pattern persisting in the arteries of the arm. Anat Rec 55:403–409

    Article  Google Scholar 

  23. Tsuruo Y, Ueyama T, Ito T, Nanjo S, Gyuobo H, Satoh K, Iida Y, Nakai S (2006) Persistent median artery in the hand: a report with a brief review of the literature. Anat Sci Int 81:242–252

    Article  PubMed  Google Scholar 

  24. Varley I, Wales CJ, Carter LM (2008) The median artery: its potential implications for the radial forearm flap. J Plast Reconstr Aesthet Surg 61:693–695

    Article  PubMed  Google Scholar 

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Acknowledgments

We thank Ailton Vieira Santos and José Bispo dos Santos, anatomy laboratory technicians in the Federal University of Sergipe, for their support in preparing the cadavers, since without their collaboration, this work could not have been accomplished.

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Correspondence to José Aderval Aragão.

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The paper has not been submitted for publication elsewhere and all authors were fully involved in the study and preparation of the manuscript. There is no conflict of interest.

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Aragão, J.A., da Silva, A.C.F., Anunciação, C.B. et al. Median artery of the forearm in human fetuses in northeastern Brazil: anatomical study and review of the literature. Anat Sci Int 92, 107–111 (2017). https://doi.org/10.1007/s12565-015-0322-x

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Keywords

  • Anatomy
  • Carpal tunnel syndrome
  • Median nerve
  • Persistent median artery
  • Superficial palmar arch