High Up Bifurcation of Brachial Artery with Twisting of Ulnar and Radial Artery Distally Along with Clubbing of Fingers-A Case Report of A Male Cadaver Died at Around 65years

The word “Brachial” is derived from the Greek word Brakion meaning ‘shorter’; brachium also means arm [1]. Normally brachial artery is a continuation of axillary artery at the inferior border of teres major muscle in axilla. Towards the distal end, it lies medial to the bicipital aponeurosis. At the level of neck of radius, in cubital fossa, artery bifurcates into two terminal branches, medially ulnar artery and laterally radial artery [2]. At the wrist, superficial and deep branches of ulnar artery form superficial palmar arch and deep palmar arch along with two branches of radial artery and radial artery runs laterally through anatomical snuff box located in between two heads of dorsal interosseous muscles [3]. There are many articles reporting variation of division of brachial artery at different levels, but mid arm variation i.e, bifurcation at the level of insertion of coracobrachialis muscle is of common occurrence [4]. Normal vascular development including patterning of the blood vessels is influenced by local hemodynamic factors. Altered hemodynamic environment may give rise to variant patterning of blood vessels [5]. Like bifurcation of brachial artery into ulnar and radial artery, there may be trifurcation of brachial artery into ulnar, radial and anterointerossei artery. Sometimes brachial artery may terminate into ulnar, radial and radial recurrent artery. Again brachial artery may trifurcate into radial, ulnar and superior ulnar collateral artery. Variations in upper limb arteries are fairly common. Major variation is present in about 25% of the subjects studied for brachial artery. The first reported arterial variation in upper limb was by Von Haller in 1813. Incidence of high division of brachial artery is 25% in various population of the world. The highest percentage of brachial artery variation is mainly trifurcation of brachial artery. Arey in 1957 highlighted that there may be persistence of vessels which normally disappear and obliterations of those which normally do exist. This is largely due to altered hemodynamic environment [6]. Effect 6 knowledge of this variation is important for day to day practice for measurement of blood pressure using sphygmomanometer cuff in the arm. Knowledge of this variation is also important to carryout surgical interventions in arm [7].