Variant Course and Branching Pattern of Arteries in the Right Cubital Fossa: Possible Embryological and Clinical Implications

Abstract

Variations in the arterial pattern of the upper extremity are numerous and have been documented. Superficially placed arteries in the cubital fossa may be mistaken for cutaneous veins and may lead to intra-arterial injection instead of the intended intra-venous one. This may lead to serious complications like haemorrhage, necrosis of forearm or digits, or arterio-venous fistula. Compression symptoms may occur when arteries run an abnormal course through muscles. We report here a rare observation during routine cadaveric dissection of the right brachial artery passing superficial to the bicipital aponeurosis and then trifurcating 2.5cm distal to the bend of elbow into radial artery, ulnar artery and a recurrent muscular branch to brachialis muscle. Radial artery was observed to pass through pronator teres muscle. Knowledge of these arterial variants is important to vascular surgeons to avoid iatrogenic accidents during grafting, microvascular surgeries and radio-diagnostic procedures. A possible embryological explanation for the arterial pattern observed is being described.