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Palmar arch anatomy: Ajmer Working Group classification

Rajendra Gokhroo1, Devendra Bisht2, Sajal Gupta1

  • 1Post Graduate Department of Cardiology, JLN Medical College & Associated Group of Hospitals, Ajmer, Rajasthan, India.

Vascular
|March 12, 2015
PubMed

Insights

This study reveals that Type A superficial palmar arches offer the best collateral circulation for forearm vessel harvesting. Type C arches, however, increase the risk of digital ischemia, highlighting the need for comprehensive collateral circulation assessment beyond the Modified Allen

Area of Science:

  • Anatomy
  • Vascular Surgery
  • Radiology

Background:

  • Forearm arteries are crucial for cardiac catheterization, bypass grafting, and hemodialysis access.
  • Limited data exists on palmar circulation in live subjects, with most information derived from cadaveric studies.
  • Understanding palmar arch variations is essential for surgical planning and preventing complications.

Purpose of the Study:

  • To investigate patterns of palmar arch circulation and forearm artery anomalies in live individuals.
  • To correlate these anatomical findings with clinical implications, particularly regarding collateral circulation.
  • To evaluate the sufficiency of the Modified Allen's test in assessing collateral flow.

Main Methods:

  • Forearm and hand arteriograms were obtained from 302 patients via radial (200) and ulnar (102) routes.
  • Angiograms were analyzed based on predetermined parameters and classified into three types (A, B, C) of superficial palmar arches.
  • The Modified Allen's test was performed on all participants.

Main Results:

  • The study identified three distinct patterns of superficial palmar arches (Type A, B, C).
  • Type A arches demonstrated sufficient collateral circulation, while Type C arches were associated with a higher risk of digital ischemia.
  • The Modified Allen's test was normal in all patients, irrespective of palmar arch type.

Conclusions:

  • Type A superficial palmar arches are ideal for forearm vessel harvesting due to robust collateral supply.
  • Type C superficial palmar arches pose a significant risk for digital ischemia following radial or ulnar artery occlusion.
  • The Modified Allen's test alone is insufficient for evaluating collateral circulation; supplementary tests are recommended before invasive procedures.
Abstract

Keywords:
Allen testPalmar archcardiac catheterization

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