A High Bifurcation of the Dorsal Branch with Dominant Superficial Palmar Branch of the Radial Artery: A Case Report of an Aberrant Radial Artery with Traumatic Aneurysm

 

PDF Download Buy Article Permissions and Reprints

Abstract

Anatomical abnormalities such as unusual bifurcations or aberrant arteries of the radial artery are extremely rare and due to malformation or disruption of the vascular net. We present a case of a 64 year old woman with a high bifurcated dorsal branch of the left radial artery, consulting us for a pulsatile mass in the anatomical snuffbox after a fall. The mass measured 3–4 mm in diameter and was located on the dorsal aspect of the wrist over the anatomical snuffbox. Primary imaging studies using Duplex Ultrasound suggested an aneurysm of the radial artery, further imaging with arteriogram revealed a high bifurcation of the dorsal branch of the radial artery, presenting with an aneurysm. The deep palmar branch of the ulnar artery was the dominating vessel, allowing ligation and excision of the aneurysm. Histological evaluation revealed intimal wall hyperplasia within the aneurysm, suggesting an injury as initiating factor. A review of the literature showed that this abnormality of high bifurcation of the dorsal palmar branch of the radial artery has not been previously reported. Management of aneurysms at the wrist is discussed.

• References

• 1 McCormack LJ, Cauldwell EW, Anson BJ. Brachial and antebrachial arterial patterns. Surg Gynecol Obstet 1953; 96: 43-54
  PubMedGoogle Scholar
• 2 Uglietta JP, Kadir S. Arteriographie study of variant arterial anatomy of the upper extremities. Cardiovase Inter Radiol 1989; 12: 145-148
  PubMedGoogle Scholar
• 3 Otsuka T, Terauehi M. An anomaly of the radial artery. Relevance for the forearm flap. Br J Plast Surg 1991; 44: 390-391
  CrossrefPubMedGoogle Scholar
• 4 Small JO, Miller R. The radial artery forearm flap: an anomaly of the radial artery. Br J Plast Surg 1988; 38: 501-503
  PubMedGoogle Scholar
• 5 Brown MJ, Edstrom LE, Zienowiez RJ. A symptomatic radial artery anomaly and its surgical treatment. J Hand Surg 1999; 24: 178-181
  CrossrefPubMedGoogle Scholar
• 6 Ieten N, Sullu Y, Tuncer I. Variant high-origin radial artery: a bilateral ease. Surg Radiol Anat 1996; 18: 63-66
  CrossrefPubMedGoogle Scholar
• 7 Van Allen MI, Hoyme HE, Jones KL. Vaseular pathogenesis of limb defects. I. Radial artery anatomy in radial aplasia. J Pediatr 1982; 101: 832-838
  CrossrefPubMedGoogle Scholar
• 8 Smith HE, Dirks M, Patterson RB. Hypothenar hammer syndrome: distal ulnar artery reeonstruetion with autologous inferior epigastric artery. J Vase Surg 2004; 40: 1238-1242
  CrossrefPubMedGoogle Scholar
• 9 Narsete EM. Traumatie aneurysm of the radial artery - a report of three eases. Am J Surg 1964; 108: 424-427
  CrossrefPubMedGoogle Scholar
• 10 Drizenko A, Maynou C, Mestdagh H, Mauroy B, Bailleul JP. Variations of the radial artery in man. Surg Radiol Anat 2000; 22: 299-303
  PubMedGoogle Scholar
• 11 Alameddine AK, Alimov VK, Engelman RM, Rousou JA, Flack JE, Deaton DW, Engelman DT. Anatomic variations of the radial artery: signifieanee when harvesting for eoronary artery bypass grafting. J Thorac Cardiovase Surg 2004; 127: 1825-1827
  PubMedGoogle Scholar
• 12 Singer E. Embryological pattern persisting in the arteries of the arm. Anat Ree 1933; 55: 403-409
  CrossrefPubMedGoogle Scholar
• 13 Barmwell-Smith R. A ease of spontaneous aneurysm of the radial artery in the tabatière: treatment by excision of the sac. Laneet 1897; 150: 1044
  PubMedGoogle Scholar
• 14 Walton NP, Choudhary F. Idiopathic radial artery aneurysm in the anatomical snuffbox. Acta Orthop Belg 2002; 68: 292-294
  PubMedGoogle Scholar
• 15 Magarelli N, Ambrosini R, Carriero A. Imaging with magnetic resonance in a ease of post-traumatic aneurysm of the radial artery. Radiol Med (Torino) 1997; 93: 214-217
  PubMedGoogle Scholar
• 16 Gooding GA. Sonography of the radial artery at the wrist. AJR Am J Roentgenol 1988; 150: 629-631
  CrossrefPubMedGoogle Scholar
• 17 Komorowska-Timek E, Teruya TH, Abou-Zamzam Jr AM, Papa D, Ballard JL. Treatment of radial and ulnar artery pseudoaneurysms using percutaneous thrombin injection. J Hand Surg [Am] 2004; 29: 936-942 PMID: 15465248
  CrossrefPubMedGoogle Scholar
• 18 Cozzi DA, Zani A, Paeilli M, Morini F. Uncomplicated iatrogenic pseudoaneurysm of the superficial palmar arch treated by excision and vascular reconstruction. Am J Crit Care 2004; 13: 315-319
  PubMedGoogle Scholar
• 19 Longo GM, Pearce WH, Sumner DS. Evaluation of upper extremity ischemia. 2005. In: Rutherford RB. (ed) Vascular Surgery. 6th edn Elsevier Saunders; Philadelphia: pp 1274-1293
  Google Scholar