Anatomical Variations of the Brachial Artery: A Systematic Review and Meta-Analysis

The brachial artery (BA) variations are important anatomical variants with significant implications for anatomists, radiologists, and surgeons. This systematic review and meta-analysis aimed to estimate the pooled prevalence of BA variations, including their types, sex distribution, laterality, side predominance, and global patterns. A systematic search was conducted across three online databases (PubMed, Hinari, and Google Scholar) as well as key anatomical journals, following the PRISMA 2020 guidelines and the Evidence-Based Anatomy Workgroup recommendations. Meta-analysis was performed using MetaXL software to calculate pooled prevalence rates and distribution characteristics of BA variations by employing a random-effects model. A total of 57 study reports met the inclusion criteria. Typical BA anatomy was observed in approximately 90% of individuals, while BA variations were present in about 10%. Variations showed significant right-side (65%) and unilateral (71%) dominance, with males accounting for 58%. The most common variant was the brachioradial artery, present in 6% of limbs and comprising 66% of all BA variations, followed by the superficial brachial artery (6% of limbs, 29% of variations) and the accessory brachial artery, seen in 4% of limbs and accounting for 32% of variations. The brachioulnar artery, a high-origin ulnar artery, was less common (2% of limbs, 12% of variations). BA variations were evenly distributed across all continents. The meta-analysis revealed high heterogeneity across studies and minor asymmetry in publication bias assessment. BA variations occur in one-tenth of the population, with consistent global distribution and distinct laterality patterns. Awareness of these variants is critical for accurate anatomical knowledge and for reducing complications in clinical and surgical procedures involving the upper limb.