Prevalence of the persistant median artery

Abstract

Introduction: Neurovascular variations in the upper limb are common and they are well documented. An accurate knowledge of the normal and the variant anatomy of the median nerve and the median artery are important for clinical procedures and for vascular surgeries. The persistant median artery is one such anomaly which was seen in 6.6% (4) of the 60 upper limbs which were dissected in the present study, it being bilateral in one cadaver.

Material and methods: The present study was conducted on 60 upper limbs of 30 cadavers at the Government Medical College, Amritsar, India. The whole course of the median nerve and the persistant median artery was exposed.

Results: In all the 4 variant limbs, the persistent median artery originated from the anterior interrosseous artery and terminated in the incomplete mediano- ulnar type of the superficial palmar arch. In three upper limbs, the persistant median artery simply accompanied the median nerve upto the palm. But in the left upper limb of the cadaver with the bilateral variation, the artery penetrated and divided the nerve into two halves which joined to form a neural loop around the artery. Thereafter, the nerve and the artery followed the same course upto the palm. Such a penetration of the median nerve by the persistent median artery is extremely rare. Further, its ontogeny and clinical implications have been discussed in detail.

Keywords: Median nerve penetration; Neurovascular variations; Persistant median artery.

[Table/Fig-1]

Photograph of right upper limb showing persistant median artery.(AIA-Anterior interosseousartery,BA-Brachial artery, FDS-Flexor digitorum superficialis, MN-Median nerve, PIA-Posterior interosseousartery, PMA-Persistant median artery, PCN1-Palmar cutaneous nerve, PCN2-Palmar cutaneous nerve, PT-Pronator teres, RA-Radial artery, UA-Ulnar artery)

[Table/Fig-2]

Photograph of left upper limb showing median nerve penetration by a persistant median artery. (AIA-Anterior interosseousartery, BA-Brachial artery,CFO-Common flexor origin, MN-Median nerve, PT-Pronator teres, PIA-Posterior interosseousartery, PMA-Persistant median artery, UA-Ulnar artery, RA-Radial artery)

[Table/Fig-3]

Photograph of left upper limb showing persistant median artery penetrating median nerve.(AIA-Anterior interosseous artery, BA-Bachial artery, MN-Median nerve, PIA-Posterior interosseousartery, PTS-Pronator teres superficial head, PTD-Pronator teresdeephead, PCN-Palmar cutaneous nerve, PCN2- Palmar cutaneous nerve, PMA-Persistant median artery, RA-Radial artery, UA-Ulnar artery)