Double brachial artery dr. kk

TITLE: Vascular injury with fracture

humerus encountered in a case of double

axillary artery and double brachial artery

- A rare clinical case report.

AUTHOURS: Dr. Sanjeev Jain

Dr. K. Kalaivanan *

Dr. Aditya C Pathak

Dr. Amish P Mhatre

INTRODUCTION

• To the best of our knowledge, such a rare combination of double axillary and double brachial arteries encountered in a case of fracture humerus with brachial artery injury is the first to report in clinical practice.

• A 30-year-old female presented to our accident and emergency department with fracture right humerus and absent right radial pulse.

CASE STUDY

• Her contrast-enhanced computed tomographicangiography revealed high bifurcation of right subclavian artery prior to axilla into two axillaryarteries.

• The axillary artery-1 continued as the superficial brachioulnar artery.

• The axillary artery-2 continued as the deep brachioradial artery with an occlusion in its flow at the level of fracture right humerus.

• Distal to the occlusion, the deep brachioradial artery continued to form intact palmar arch with superficial brachioulnar artery.

CASE STUDY

• The fracture humerus was fixed with plate osteosynthesis and bone grafting.

• Non-invasive treatment method was chosen for brachial artery injury, intraoperatively.

• With a complete clinico-radiological investigation and better preoperative planning, we protected her superficial brachioulnar artery from iatrogenic injury.

CONCLUSION

The key message of our study is that

“every trauma case needs a thorough

clinical examination and an adequate

radiological examination with proper

preoperative planning to avoid iatrogenic

injury”.

This rare branching pattern is named as

“Jain Variation” for literature support.

CT ANGIOGRAPH

Axillary artery-2

continued as the

deep brachioradial

artery with an

occlusion in its flow

at the level of

fracture.

FRACTURE PATTERN

• A - X-RAY AP VIEW

# HUMERUS.

• B - X-RAY LATERAL

VIEW # HUMERUS.

• C - X-RAY AP VIEW

HUMERUS PLATING.

• D - X-RAY LATERAL

VIEW HUMERUS

PLATING.

REFRENCES

[1] Rodriguez-Niedenfuhr M, Burton GJ, Deu J, Sanudo JR. Development of the arterial pattern in the upper limb of staged human embryos: normal development and anatomic variations. J Anat. 2001; 199: 407–417.

[2] Rodriguez-Niedenfuhr M, Vazquez T, Nearn L, Ferreira B, Parkin I, Sanudo JR. Variations of the arterial pattern in the upper limb revisited: a morphological and statistical study, with a review of the literature. J Anat. 2001; 199: 547–566.

[3] Deligonul U, Gabliani G, Kern MJ, Vandormael M. Percutaneous brachial catheterization: the hidden hazard of high brachial artery bifurcation. Cathet Cardiovasc Diagn. 1988; 14: 44–45.

[4] Prithishkumar IJ, Chathu M. A rare, variant overlapping of the brachioradial and the deep brachial artery in the arm: a potential hazard for angiography. J Clin Diagn Res. 2011; 5: 862–864.

[5] VijayaBhaskar P, Ritesh R, Shankar PR. Anomalous branching of the axillary artery: A case report. Kathmandu Univ Med J (KUMJ). 2006; 4: 517–519.

[6] Jayakumari S, Rath G, Arora J. Unilateral double axillary and double brachial arteries. Embryological basis and clinical implications. Int J Morphol. 2006; 24: 463–468.

[7] Jurjus AR, Correa-De-Aruaujo R, Bohn RC. Bilateral double axillary artery: embryological basis and clinical implications. Clin Anat. 1999; 12: 135–140.

[8] Hunt CA, Kingsley JR. Vascular injuries of the upper extremity. South Med J. 2000; 93: 466–468.

[9] Mirdad TM. Neuro-Vascular injuries associated with limb fractures. East Afr Med J. 2000; 77: 663–666.

[10] Johansen K, Lynch K, Paun M, Copass M. Noninvasive vascular tests reliably exclude occult arterial trauma in injured extremities. J Trauma. 1991; 31: 515–519.