Abstract
Purpose
This study was conducted to demonstrate morphological pattern of the ulnar artery and to evaluate morphometrically its anatomical branching pattern in human fetuses.
Methods
Branching pattern of ulnar artery was evaluated on 121 upper limbs of dissected 63 of formalin-fixed fetus cadavers with gestational age ranging from 17 to 40 weeks. In order to obtain second and third trimester data, according to their gestational age, two groups were determined.
Results
In 79 of all 121 upper limbs (65%) ulnar artery gave anterior and posterior ulnar recurrent arteries as separate branches. In this study frequency of presence of a median artery was 46.28% among total examined 121 upper limbs. Median arteries originated from ulnar artery (3.57%) and from the common interosseous artery (53.57%) and anterior interosseous artery (42.85%). Mean distances of the measured parameters were demonstrated according to the gestational age and differences between group I (second trimester) and group II (third trimester). No statistical difference for groups was observed for gender and between right and left sides.
Conclusions
Ulnar artery shows predictable patterns during second and third trimester of fetal period and can be suitable access effective alternative for diagnostic and therapeutic coronary interventions. Persistent median artery is important variation and knowledge of its incidence is important for diagnostic difficulties and also during awareness of its injury during surgical approaches.
Similar content being viewed by others
References
Adachi B (1928) Das arteriensystem der Japaner. Maruzen, Kyoto, pp 348–356
Ahn DS, Yoon ES, Koo SH, Park SH (2000) A prospective study of the anatomic variations of the median nerve in the carpal tunnel in Asians. Ann Plast Surg 44:282–287
Aragão JA, da Silva AC, Anunciação CB, Reis FP (2017) Median artery of the forearm in human fetuses in northeastern Brazil: anatomical study and review of the literature. Anat Sci Int 92:107–111
Bergman RA, Afifi AK, Miyauchi R (1992–2004) Opus II: cardiovascular system: arteries: upper limb, In: Illustrated encyclopedia of human anatomic variation. http://www.anatomyatlases.org/AnatomicVariants/Cardiovascular/Text/Arteries/Median.shtml. Accessed 7 May 2018
Bergman RA, Thompson SA, Afifi AK, Saadeh FA (1988) Compendium of human anatomic variation. Urban & Schwarzenberg, Baltimore, pp 72–75
Christie DR, Duncan GM, Glasson DW (1994) The ulnar artery free flap: the first 7 years. Plast Reconstr Surg 93:547–551
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
Constantino ER, de Paula RC, Rodrigues MR, Fernandes RM (2009) Artéria mediana persistente: abordagem anatômica e implicações clinicas. Acta Sci Med 2:58–63
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
Federative Committee of Anatomical Terminology (FCAT) (1998) Terminologia anatomica. Thieme Verlag, Stuttgart
George BJ, Henneberg M (1996) High frequency of the median artery of the forearm in South African newborns and infants. S Afr Med J 86:175–176
Gokhroo R, Bisht D, Padmanabhan D, Gupta S, Kishor K, Ranwa B (2015) Feasibility of ulnar artery for cardiac catheterization: AJmer ULnar ARtery (AJULAR) catheterization study. Catheter Cardiovasc Interv 86:42–48
Guimberteau JC, Goin JL, Panconi B, Schuhmacher B (1988) The reverse ulnar artery forearm island flap in hand surgery: 54 cases. Plast Reconstr Surg 81:925–932
Haerle M, Häfner HM, Dietz K, Schaller HE, Brunelli F (2003) Vascular dominance in the forearm. Plast Reconstr Surg 111:1891–1898
Hayashi A, Maruyama Y, Saze M, Okada E (2004) Ulnar recurrent adipofascial flap for reconstruction of massive defects around the elbow and forearm. Br J Plast Surg 57:632–637
Hazlett JW (1949) The superficial ulnar artery with reference to accidental intra-arterial injection. Can Med Assoc J 61:289–293
Henneberg M, George BJ (1995) Possible secular trend in the incidence of an anatomical variant: median artery of the forarm. Am J Phys Anthropol 96:329–334
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
Hubmer MG, Fasching T, Haas F, Koch H, Schwarzl F, Weiglein A, Scharnagl E (2004) The posterior interosseous artery in the distal part of the forearm. Is the term “recurrent branch of the anterior interosseous artery” justified? Br J Plast Surg 57:638–644
Jones NF, Ming NL (1988) Persistent median artery as a cause of pronator syndrome. J Hand Surg Am 13:728–732
Kopuz C, Baris S, Gulman B (1997) A further morphological study of the persistent median artery in the neonatal cadavers. Surg Radiol Anat 19:403–406
Kopuz C, Gulman B, Baris S (1995) Persistent median artery: an anatomical study in neonatal and adult cadavers. Kaibogaku Zasshi 70:577–580
Lippert H, Pabst R (1985) Arterial variations in man. Classification and frequency. JF Bergmann Verlag, Munchen, pp 69–73
Lovie MJ, Duncan GM, Glasson DW (1984) The ulnar artery forearm free flap. Br J Plast Surg 37:486–492
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
McCormack LJ, Claudwell EW, Anson BJ (1953) Brachial and anterbrachial arterial patterns. A study of 750 extremities. Surg Gynecol Obstet 96:43–54
Moore KL (1992) Clinically oriented anatomy, 3rd edn. Lippincott Williams & Wilkins, Baltimore, p 751
Natsis K, Papadopoulou AL, Paraskevas G, Totlis T, Tsikaras P (2006) High origin of a superficial ulnar artery arising from the axillary artery: anatomy, embryology, clinical significance and a review of the literature. Folia Morphol 65:400–405
Nunoo-Mensah J (1998) An unexpected complication after harvesting of the radial artery for coronary artery bypass grafting. Ann Thorac Surg 66:929–931
Prantl L, Schreml S, Schwarze H, Eisenmann-Klein M, Nerlich M, Angele P, Jung M, Füchtmeier B (2008) A safe and simple technique using the distal pedicled reversed upper arm flap to cover large elbow defects. J Plast Reconstr Aesthet Surg 61:546–551
Roberts EB, Palmer N, Perry RA (2007) Transulnar access for coronary angiography and intervention: an early review to guide research and clinical practice. J Invasive Cardiol 19:83–87
Rodriguez-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(Pt 4):407–417
Rodriguez-Niedenführ M, Sañudo JR, Vazquez T, Logan B, Nearn L, Parkin I (1999) Median artery revisited. J Anat 195:57–63
Rodríguez-Niedenführ M, Vázquez T, Nearn L, Ferreira B, Parkin I, Sañudo JR (2001) Variations of the arterial pattern in the upper limb revisited: a morphological and statistical study, with a review of the literature. J Anat 199(Pt 5):547–566
Rodriguez-Niedenführ M, Vazquez 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
Singer E (1933) Embryological pattern persisting in the arteries of the arm. Anat Rec 55:403–409
Sieg P, Jacobsen HC, Hakım SG, Hermes D (2006) Superficial ulnar artery: curse or blessing in harvesting fasciocutaneous forearm flaps. Head Neck 28:447–452
Standring S (2008) Gray’s anatomy: the anatomical basis of clinical practice, 40th edn. Elsevier Saunders, Philadelphia, p 835 (Chap. 48)
Thoma A, Young JEM (1992) The superficial ulnar artery “trap” and the free forearm flap. Ann Plast Surg 28:370–372
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
Vollala VR, Jetti R, Soni S (2011) High origin of an ulnar artery–development and surgical significance. Chang Gung Med J 34:39–42
Yildiz S, Kocabiyik N, Ozer CM (2014) Variations associated with high division of the superficial brachial artery. Int J Anat Var 7:45–47
Acknowledgements
This work was not supported by grant funding.
Author information
Authors and Affiliations
Contributions
SY, NK, AC designed this study; SY, OE and AC performed anatomical dissections; NK and BY analyzed the data; SY and AC wrote the manuscript.
Corresponding author
Ethics declarations
Conflict of interest
None of the authors have any conflict of interest with the content of this manuscript.
Disclaimer
None.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Yildiz, S., Kocabiyik, N., Elvan, O. et al. Branches of ulnar artery in human fetuses: anatomical and morphometric study. Surg Radiol Anat 41, 1325–1332 (2019). https://doi.org/10.1007/s00276-019-02297-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00276-019-02297-6