A study of arterial variations of upper limb among medical students and staff in IIUM Kuantan

Abstract

The arterial pattern of the upper limb is one of the systems that shows a large number of variations in the adult. These variations have been observed frequently either in routine dissections or in clinical practice. It is very important to understand the arterial variations of the arm because procedures are commonly performed on the upper extremity vessels, in cases of acute arterial injury and occlusion. Although the variability of vascular anatomy of upper extremity has been studied in large numbers of dissections, there is few information on the arterial variations in vivo. This is the first study done in Malaysia on the vascular patterns of arm and forearm in vivo using the Doppler ultrasonography. There were eight hundred upper limbs (400 subjects of staff and students of International Islamic University Malaysia) examined with Logiq P5 General Electric Ultrasound machine using 12L-RS linear probe. From the axilla to the wrist, the brachial-antebrachial arterial system was mapped to determine the variations. The data was analyzed with statistical package SPSS 19. Among them, 6.1% of the upper limbs were found to possess the variants. There are seven types of variants encountered which are (a) PMA with 2.6% (21 cases) , (b) brachioradial artery (BRA) 1.7% (14 cases), (c) superficial brachioulnar artery (SBUA) 1.2% (10 cases) , (d) double radial artery (DRA) 0.6% (5 cases), (e) brachioulnar artery (BUA) 0.2% (2 cases), (f) radial artery loop 0.1% (1 case), and (g) aberrant radial artery 0.1% (1 case). Variations found in the arms are the BRA, SBUA and BUA while in the forearm are PMA, DRA, aberrant RA and RA loop. Among them four cases with PMA were associated SBUA, BUA, BRA and aberrant RA on the same side of the upper limbs. Another case possessed BRA together with DRA. It is more common in females (22 subjects) than males (20 subjects), and on the right side (28 cases) than the left (21 cases). However, these differences are not statistically significant (p > 0.05). Variant anatomy of the brachial and antebrachial arteries in this population occurs in approximately 10.5%. Academically, this provides and expands the existing fundamental anatomical knowledge. Clinically, the knowledge of the vascular pattern of Malaysian populations will benefit in elevation of arterial flaps and can also avoid intra arterial injuries and complications during any upper limb vascular procedures