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. 2024 Apr 8:23:e20230117.
doi: 10.1590/1677-5449.202301172. eCollection 2024.

Assessment of anatomic variations of the brachial artery bifurcation using vascular Doppler ultrasound: a cross-sectional study

Mariana Jordão França  1 , Graciliano José França  1   2 , Luciana Akemi Takahashi  2 , Solena Ziemer Kusma Fidalski  2 , Eduarda Casagrande Zanoni  1
Affiliations

Assessment of anatomic variations of the brachial artery bifurcation using vascular Doppler ultrasound: a cross-sectional study

Mariana Jordão França et al. J Vasc Bras. .

Abstract
in English, Portuguese

Background: Anatomical variations in arteries of the upper limb, such as presence of an accessory brachial artery, are common and widely described in the literature, mainly in cadaveric studies, but it is now possible to diagnose them using vascular Doppler ultrasound.

Objectives: To identify the incidence of accessory brachial artery using vascular Doppler ultrasound and compare the findings with cadaveric studies.

Methods: This was a prospective study that examined 500 upper limbs of 250 volunteers assessed with vascular Doppler ultrasound using the Sonosite Titan portable ultrasound machine.

Results: 15.6% of the participants in our study had the accessory brachial artery anatomical variation. Our percentage is in line with the average rates found in cadaveric studies, which ranged from 0.2% to 22%. Being aware of this variation is fundamental in procedures such as peripheral venipuncture, arteriovenous fistula creation, catheterization, forearm flaps, emergency surgeries on the limb and even correction of fractures by cast.

Conclusions: The accessory brachial artery is a frequent variant in the upper limb. The percentage of individuals with an accessory brachial artery in our study was 15.6%, which agrees with data from the literature on cadaveric studies.

Contexto: Variações anatômicas em artérias do membro superior, como a presença da artéria braquial acessória, são comuns e amplamente descritas na literatura, principalmente por estudos em cadáveres. No entanto, atualmente, é possível realizar o diagnóstico através do eco-Doppler vascular.

Objetivos: Identificar a incidência da artéria braquial acessória pelo eco-Doppler e comparar os achados com estudos cadavéricos.

Métodos: Tratou-se de um estudo prospectivo em 500 membros superiores de 250 voluntários avaliados pelo eco-Doppler com o aparelho portátil de ultrassom Sonosite Titan.

Resultados: Dos participantes do nosso estudo, 15,6% apresentaram a variação anatômica da artéria braquial acessória. A porcentagem está dentro da média encontrada em estudos cadavéricos, que varia de 0,2 até 22%. Ter conhecimento dessa variação é fundamental em procedimentos como punção venosa periférica, fístula arteriovenosa, cateterismo, retalhos de antebraço, cirurgias de emergência no membro superior e até mesmo correção de fraturas por gesso.

Conclusões: A artéria braquial acessória é uma variante frequente no membro superior. O percentual de indivíduos com a artéria braquial acessória em nosso estudo foi de 15,6% e coincide com os dados da literatura de estudos cadavéricos.

Keywords: Doppler ultrasound; anatomical variation; brachial artery.

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Conflict of interest statement

Conflicts of interest: No conflicts of interest declared concerning the publication of this article.

Figures

Figure 1
Figure 1. Flow diagram illustrating inclusion of patients in the study. FICF = free and informed consent form.
Figure 2
Figure 2. Doppler ultrasound in transverse view showing just the principal brachial artery, indicating that there is no anatomic variant of the artery.
Figure 3
Figure 3. Doppler ultrasound in longitudinal view, showing the principal brachial artery
Figure 4
Figure 4. Doppler ultrasound in spectral mode, longitudinal view, showing normal flow in the brachial artery.
Figure 5
Figure 5. Schematic diagram illustrating Doppler ultrasound in transverse view. (A) indicates the skin and subcutis, (B) the principal brachial artery, and (C) the anterior muscles of the arm.
Figure 6
Figure 6. Schematic diagram illustrating Doppler ultrasound in longitudinal view. (B) indicates the principal brachial artery and (C) the anterior muscles of the arm.
Figure 7
Figure 7. Doppler ultrasound in transverse view showing an accessory brachial artery and the principal brachial artery, indicating that there is an anatomic variant of the artery.
Figure 8
Figure 8. Doppler ultrasound in longitudinal view, showing an accessory brachial artery and the principal brachial artery.
Figure 9
Figure 9. Schematic diagram illustrating Doppler ultrasound in transverse view. (A) indicates the skin and subcutis, (B) the principal brachial artery, (C) the anterior muscles of the arm, and (D) the accessory brachial artery
Figure 10
Figure 10. Schematic diagram illustrating Doppler ultrasound in longitudinal view. (B) indicates the principal brachial artery, (C) the anterior muscles of the arm, and (D) the accessory brachial artery.
Figura 1
Figura 1. Fluxograma dos pacientes incluídos no estudo. TCLE = termo de consentimento livre e esclarecido.
Figura 2
Figura 2. Eco-Doppler em corte transversal demonstrando a presença de apenas a artéria braquial principal, indicando que não há variação anatômica dessa artéria.
Figura 3
Figura 3. Eco-Doppler em corte longitudinal demonstrando a artéria braquial principal.
Figura 4
Figura 4. Eco-Doppler em modo espectral, corte longitudinal, demonstrando fluxo normal na artéria braquial.
Figura 5
Figura 5. Desenho esquemático demonstrando eco-Doppler no corte transversal. Em (A) estão sinalizados pele e subcutâneo, em (B) artéria braquial principal e em (C) músculos anteriores do braço.
Figura 6
Figura 6. Desenho esquemático demonstrando eco-Doppler no corte longitudinal. Em (B) está sinalizada a artéria braquial principal e em (C) músculos anteriores do braço.
Figura 7
Figura 7. Eco-Doppler em corte transversal demonstrando a presença da artéria braquial acessória e da artéria braquial principal, indicando que há variação anatômica dessa artéria.
Figura 8
Figura 8. Eco-Doppler em corte longitudinal demonstrando a artéria braquial acessória e a artéria braquial principal.
Figura 9
Figura 9. Desenho esquemático demonstrando eco-Doppler no corte transversal. Em (A) estão sinalizados pele e subcutâneo, em (B) artéria braquial principal, em (C) músculos anteriores do braço e em (D) a artéria braquial acessória.
Figura 10
Figura 10. Desenho esquemático demonstrando eco-Doppler no corte longitudinal. Em (B) está sinalizada a artéria braquial principal, em (C) músculos anteriores do braço e em (D) a artéria braquial acessória.
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