Median artery persistence in coexistence with a bifid median nerve and interconnections of the median with the ulnar nerve and vice versa,Surgical and Radiologic Anatomy

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Median artery persistence in coexistence with a bifid median nerve and interconnections of the median with the ulnar nerve and vice versa
Surgical and Radiologic Anatomy ( IF 1.2 ) Pub Date : 2023-06-27 , DOI: 10.1007/s00276-023-03183-y
Maria Piagkou ₁ , George Tsakotos ₁ , George Triantafyllou ₁ , Christos Koutserimpas ₂ , Trifon Totlis ₃ , Vasilios Karampelias ₁ , Konstantinos Natsis ₃

Affiliation

Purpose

This report describes a bilateral persistent median artery (PMA) originating from the ulnar artery and terminating at different levels of the upper limb. The PMA coexisted with a bilateral bifid median nerve (MN) and two bilateral interconnections (ICs characterized with the symbol -) of the MN with the ulnar nerve (UN) (MN-UN) and a unilateral reverse IC (UN-MN). Emphasis was given to the artery’s developmental background.

Methods

The PMA was identified in an 80-year-old formalin-embalmed donated male cadaver.

Results

The right-sided PMA terminated at the wrist, posterior to the palmar aponeurosis. Two neural ICs were identified: the UN joined the MN deep branch (UN-MN), at the forearm’s upper third, and the MN deep stem joined the UN palmar branch (MN-UN), at the lower third (9.7 cm distally to the 1st IC). The left-sided PMA ended in the palm giving off the 3rd and 4th proper palmar digital arteries. An incomplete superficial palmar arch was identified by the contribution of the PMA, radial, and ulnar arteries. After the MN bifurcation into superficial and deep branches, the deep branches formed a loop, that was penetrated by the PMA. The MN deep branch communicated with the UN palmar branch (MN-UN).

Conclusions

The PMA should be evaluated as a causative factor of carpal tunnel syndrome. The modified Allen's test and the Doppler ultrasound may detect the arterial flow and the angiography may depict the vessel thrombosis in complex cases. PMA could also be a "salvage" vessel for the hand supply, in radial and ulnar artery trauma.

中文翻译：

正中动脉与双叉正中神经共存，正中动脉与尺神经相互连接，反之亦然

目的

本报告描述了源自尺动脉并终止于上肢不同水平的双侧持续正中动脉（PMA）。PMA 与双侧双歧正中神经 (MN) 和 MN 与尺神经 (UN) (MN-UN) 的两个双侧互连 (IC，以符号 - 为特征) 和单侧反向 IC (UN-MN) 共存。重点是动脉的发育背景。

方法

PMA 在一具经过福尔马林防腐处理的 80 岁捐赠男性尸体中被发现。

结果

右侧 PMA 终止于手腕，位于掌腱膜后方。确定了两个神经 IC：UN 在前臂上三分之一处连接 MN 深支 (UN-MN)，而 MN 深干在下三分之一处（距手臂远端 9.7 厘米）连接 UN 掌支 (MN-UN)。第一个 IC）。左侧 PMA 终止于手掌，发出第 3 和第 4 掌指固有动脉。通过 PMA、桡动脉和尺动脉的贡献，识别出不完整的浅表掌弓。MN 分叉为浅层分支和深层分支后，深层分支形成一个环，被 PMA 穿透。MN深支与UN掌支（MN-UN）相通。