A population study of variations in the brachial artery and its terminal branches: Clinical correlates
Published 2025-12-30
Keywords
- Brachial artery,
- ulnar artery,
- median artery,
- radial artery
How to Cite
Copyright (c) 2025 Patria Hartman, Nkosipendule Xhakaza

This work is licensed under a Creative Commons Attribution 4.0 International License.
Abstract
Reports in the literature suggest that the variations in branching patterns of the upper limb arteries and their prevalence may be influenced by sex and population affinity. A comprehensive investigation of branching patterns of the brachial artery and its branches is lacking in South Africans, with many reports focusing on the axillary artery. Therefore the current study aimed to record the incidence of the variations of the brachial, radial and ulnar arteries in a sample of the South African population. One hundred and eighty (180) upper limbs of 90 South African cadavers from the Department of Anatomy at Sefako Makgatho Health Sciences University were dissected. Normal anatomy according to standard anatomy textbooks and variant branching patterns of the brachial, radial and ulnar arteries were identified and recorded. SPSS software was used to establish the differences in variant branching patterns between side and sex. Upper limb arterial variations appeared in all the dissected cadavers. The recorded variations ranged from abnormal origin of the deep brachial artery, high division of the brachial artery into the ulnar and radial arteries, tortuous brachial and radial arteries, and superficial course of radial and ulnar arteries. The prevalence of brachial, ulnar and radial artery variations in the current study is comparable to that of previous studies. However, the superficial radial artery is more prevalent in males than in females in South Africans. The results of the current study provide crucial information for planning surgical procedures and interpretation of angiograms.
References
- 1. Tsoucalas G, Eleftheriou A, Panagouli E. High Bifurcation of the Brachial Artery: An Embryological Overview. Cureus. 2020 Feb 25.
- 2. De Garis CF, Swartley WB. The axillary artery in white and negro stocks. Am J Anat. 1928 May;41(2):353–97.
- 3. Huelke DF. Variation in the origins of the branches of the axillary artery. Anat Rec. 1959 Sep;135(1):33–41.
- 4. Astik R, Dave U. Variations in branching pattern of the axillary artery: a study in 40 human cadavers. J Vasc Bras. 2012 Mar;11(1):12–7.
- 5. Majumdar S, Bhattacharya S, Chatterjee A, Dasgupta H. A Study on Axillary Artery and its Branching Pattern among the Population of West Bengal, India. 2013;
- 6. Xhakaza NK, Satyapal KS. Origin of the subscapular artery in the South African Black population. Folia Morphol. 2014 Nov 28;73(4):486–91.
- 7. Bhat KM, Gowda S, Potu BK, Rao MS. A unique branching pattern of the axillary artery in a South Indian male cadaver. 2008;
- 8. Casal D, Pais D, Toscano T, Bilhim T, Rodrigues L, Figueiredo I, et al. A rare variant of the ulnar artery with important clinical implications: a case report. BMC Res Notes. 2012 Dec;5(1):660.
- 9. Piagkou M, Totlis T, Panagiotopoulos NA, Natsis K. An arterial island pattern of the axillary and brachial arteries: a case report with clinical implications. Surg Radiol Anat. 2016 Oct;38(8):975–8.
- 10. Nkomozepi P, Xhakaza N, Swanepoel E. Superficial brachial artery: a possible cause for idiopathic median nerve entrapment neuropathy. Folia Morphol. 2017 Sep 7;76(3):527–31.
- 11. Pham XBD, Kim JJ, Parrish AB, Tom C, Ihenachor EJ, Mina D, et al. Racial and Gender Differences in Arterial Anatomy of the Arm. Am Surg. 2016 Oct ;82(10):973–6.
- 12. Kumar Singla R. Prevalence of the Persistant Median Artery. J Clin Diagn Res. 2012;
- 13. Konarik M, Musil V, Baca V, Kachlik D. Upper limb principal arteries variations: A cadaveric study with terminological implication. Bosn J Basic Med Sci. 2020 Apr 6.
- 14. Henneberg M, George BJ. High incidence of the median artery of the forearm in a sample of recent Southern African cadavers. 1991;
- 15. Cheruiyot I, Bundi B, Munguti J, Olabu B, Ngure B, Ogeng’o J. Prevalence and anatomical pattern of the median artery among adult black Kenyans. Anat J Afr. 2017 Nov 30;6(3):1015–23.
- 16. Claassen H, Schmitt O, Wree A. Large patent median arteries and their relation to the superficial palmar arch with respect to history, size consideration and clinic consequences. Surg Radiol Anat. 2008 Feb;30(1):57–63.
- 17. Aharinejad S, Nourani F, Hollensteiner H. Rare case of high origin of the ulnar artery from the brachial artery. Clin Anat. 1997;10(4):253–8. A
- 18. Natsis K, Papadopoulou AL, Paraskevas G, Totlis T, Tsikaras P. High origin of a superficial ulnar artery arising from the axillary artery: anatomy, embryology, clinical significance and a review of the literature. Folia Morphol. 2006;65(4).
- 19. Haładaj R, Wysiadecki G, Dudkiewicz Z, Polguj M, Topol M. The High Origin of the Radial Artery (Brachioradial Artery): Its Anatomical Variations, Clinical Significance, and Contribution to the Blood Supply of the Hand. BioMed Res Int. 2018 Jun 11;2018:1–11.
- 20. Lufukuja G. High Bifurcation of Brachial Artery and its Clinical Significance. 2018;
- 21. Habib J, Baetz L, Satiani B. Assessment of collateral circulation to the hand prior to radial artery harvest. Vasc Med. 2012 Oct;17(5):352–61.
- 22. Bozer C, Ulucam E, Kutoglu T. A case of originated high superficial ulnar artery. Trakia J Sci. 2004;2(3).
- 23. Carter Y, Bennett DJ, Molla V, Wink AE, Collins AJ, Giannaris EL. A case of distal limb arterial tortuosity and dilation: observations and potential clinical significance. Folia Morphol. 2022 Aug 24;81(3):791–7.
- 24. Han HC. Twisted Blood Vessels: Symptoms, Etiology and Biomechanical Mechanisms. J Vasc Res. 2012 ; 49(3):185–97.
- 25. Mishra AK, Mishra A. Tortuous forearm arteries and its clinical implications: A Case Report. 2017;
- 26. Osiak K, Elnazir P, Mazurek A, Pasternak A. Prevalence of the persistent median artery in patients undergoing surgical open carpal tunnel release: A case series. Transl Res Anat. 2021 Jun;23:100113.
- 27. Natsis K, Iordache G, Gigis I, Kyriazidou A, Lazaridis N, Noussios G, et al. Persistent median artery in the carpal tunnel: anatomy, embryology, clinical significance, and review of the literature. Folia Morphol. 2009;68(4).
- 28. Standring S, editor. Gray’s anatomy: the anatomical basis of clinical practice. Forty-first edition. New York: Elsevier Limited; 2016. 1562 p.
- 29. Rodríguez-Niedenführ M, Vázquez T, Nearn L, Ferreira B, Parkin I, Sañudo JR. Variations of the arterial pattern in the upper limb revisited: a morphological and statistical study, with a review of the literature. J Anat. 2001 Nov; 199(5):547–66.
- 30. Chakravarthi KK. Anatomical Variations of Brachial Artery - Its Morphology, Embryogenesis and Clinical Implications. J Clin Diagn Res. 2014.
- 31. Shetty H, Patil V, Mobin N, Gowda MHN, Puttamallappa VS, Vamadevaiah RM, et al. Study of course and termination of brachial artery by dissection and computed tomography angiography methods with clinical importance. Anat Cell Biol. 2022 Sep 30;55(3):284–93.
- 32. Keen JA. A study of the arterial variations in the limbs, with special reference to symmetry of vascular patterns. Am J Anat . 1961 May;108(3):245–61.
- 33. Zheng Y, Shao L, Mao J yuan. Bilaterally symmetrical congenital absence of radial artery: a case report. BMC Surg. 2014 Dec;14(1):15.
- 34. Singh R. Abnormal origin of posterior circumflex humeral artery and subscapular artery: case report and review of the literature. J Vasc Bras. 2017 Aug 21;16(3):248–51.
- 35. Deligonul U, Gabliani G, Kern MJ, Vandormael M. Percutaneous brachial catheterization: The hidden hazard of high brachial artery bifurcation. Cathet Cardiovasc Diagn. 1988; 14(1):44–5.
- 36. Moore KL, Dalley IAF, Agur AMR. Clinically Oriented Anatomy. 2018;
- 37. Singh D, Malhotra M, Agarwal S. Variations in the Axillary Artery Branching Pattern. J Clin Diagn Res. 2020.
- 38. Yazar F, Kirici Y, Ozan H, Aldur MM. An unusual variation of the superficial ulnar artery. Surg Radiol Anat. 1999 May;21(2):155–7.
- 39. Mahajan R, Raheja S, Tuli A, Singh S, Agarwal S. Tortuous ulnar artery and Gantzer’s muscle: A rare presentation with clinical implications. 2015;
- 40. Eid N, Ito Y, Shibata MA, Otsuki Y. Persistent median artery: Cadaveric study and review of the literature. Clin Anat. 2011 Jul;24(5):627–33.
- 41. Henneberg M, George BJ. A further study of the high incidence of the median artery of the forearm in Southern Africa. 1992;
- 42. Dobrin PB, Canfield TR. Elastase, collagenase, and the biaxial elastic properties of dog carotid artery. Am J Physiol-Heart Circ Physiol. 1984 Jul 1;247(1):H124–31. A
- 43. Leeson CR, Leeson TS. Histology. 4th ed. Philadelphia: W.B. Saunders; 1981. 600 p.
- 44. Nichols WW, O’Rourke M, Vlachopoulos C, Edelman ER. McDonald’s Blood Flow in Arteries: Theoretical, Experimental and Clinical Principles. 7th ed. Boca Raton: CRC Press; 2022.
- 45. Hutchins GM, Miner MM, Bulkley BH. Tortuosity as an index of the age and diameter increase of coronary collateral vessels in patients after acute myocardial infarction. Am J Cardiol. 1978 Feb;41(2):210–5.
- 46. Wysiadecki G, Polguj M, Haładaj R, Topol M. Low origin of the radial artery: a case study including a review of literature and proposal of an embryological explanation. Anat Sci Int. 2017 Mar;92(2):293–8. A
- 47. Tank PW, Grant JCB. Grant’s dissector: Patrick W. Tank. 15th ed. Philadelphia: Lippincott Williams & Wilkins; 2013. 285 p.
- 48. Gonzalez-Compta X. Origin of the radial artery from the axillary artery and associated hand vascular anomalies. J Hand Surg. 1991 Mar;16(2):293–6.
- 49. Singh R, Malhotra R, Wadhawan M. Anomalies of radial and ulnar arteries. J Vasc Bras. 2017 Mar;16(1):56–9.
- 50. Jacquemin G, Lemaire V, Medot M, Fissette J. Bilateral case of superficial ulnar artery originating from axillary artery. Surg Radiol Anat. 2001 Jun;23(2):139–43.
- 51. Vollala VR, Jetti R, Soni S. High Origin of An Ulnar Artery – Development and Surgical Significance. 2011;34(6).
- 52. Senanayake KJ, Salgado S, Rathnayake MJ, Fernando R, Somarathne K. A rare variant of the superficial ulnar artery, and its clinical implications: a case report. J Med Case Reports. 2007 Dec;1(1):128. A
- 53. Paula RCD, Erthal R, Fernandes RMP, Babinski MA, Silva JG, Chagas CAA. Anomalous origin of the deep brachial artery (profunda brachii) observed in bilateral arms: case report. J Vasc Bras. 2013 Mar;12(1):53–6.
- 54. Morsy MA, Khan A, Chemla ES. Prosthetic axillary-axillary arteriovenous straight access (necklace graft) for difficult hemodialysis patients: A prospective single-center experience. J Vasc Surg. 2008 Nov;48(5):1251-1254.e1.
- 55. Olinger A, Benninger B. Branching patterns of the lateral thoracic, subscapular, and posterior circumflex humeral arteries and their relationship to the posterior cord of the brachial plexus. Clin Anat. 2010 May;23(4):407–12.
- 56. Park HJ, Kim S, Kim S, Song WC, Kim HJ. The radial artery running over the anatomical snuffbox: a case report. Surg Radiol Anat. 2022 May;44(5):659–63.
- 57. Ariyo O. A High Origin Subscapular Trunk and its Clinical Implications. Anat Physiol. 2018;08(02).
