Unilateral High Brachial Artery Bifurcation Encountered During Cadaveric Dissection: An Anatomical Case Report

Any difference in the pattern of branching of the brachial artery has clinical significance, that is, they possess surgical significance such as the formation of a hematoma during ligation and vascular grafting. Another significant rare anatomical variant that is important for clinicians to know is the high branching of the brachial artery. An unusual or high bifurcation of the brachial artery was seen in the superior one-third of the arm of the right upper extremity of an adult female cadaver during regular cadaveric dissection. Using the ruler method, it was measured that the brachial artery bifurcated into the radial and ulnar arteries at 4.5 cm distal to the point of insertion of the teres major muscle (far above another common site of bifurcation in the cubital fossa). The median nerve travelled between both terminal branches. The radial artery followed the downward course of the arm at a lateral position, whereas the ulnar artery followed the same path at a medial position. The profunda brachii artery branched off the brachial artery, although it did so prior to the brachial artery dividing into two. On examination of the left upper limb, it was evident that the brachial artery was normal and divided into two branches at the cubital fossa. This case underlines the significance of the identification of anatomical differences in the arteries of the upper extremity. High bifurcation of the brachial artery has significant clinical implications; knowledge of this brachial artery variation is important for surgeons performing arterial cannulation and vascular access procedures of the upper limb, as well as for interventional radiologists, anesthesiologists placing arterial lines, and clinicians interpreting vascular imaging studies. Knowledge of such variations is crucial to avoid iatrogenic injuries and ensure successful clinical outcomes. Preoperative imaging and anatomical knowledge are crucial in the process of discovering these variants.