Unusual and High Origin of Terminal Branches of the Brachial Artery: A Cadaveric Study With Embryological and Clinical Correlations.

BACKGROUND

The brachial artery constitutes the dominant arterial supply of the upper extremity and undergoes terminal division into the radial and ulnar arteries within the cubital fossa at the level of the radial neck. Deviations from this classic bifurcation pattern, whether in its location or configuration, carry substantial implications for both anatomical knowledge and clinical practice.

OBJECTIVES

To systematically document and characterize instances of anomalous, proximally displaced terminal branches of the brachial artery observed during routine anatomical dissection and to interpret these findings within their embryological context alongside their implications for contemporary clinical and surgical practice.

MATERIALS AND

METHODS

A retrospective observational investigation was conducted on 116 upper extremities from 58 embalmed adult cadavers over a continuous 14-year period (2011-2025), conducted jointly at two academic anatomy departments. All arterial structures, from the axilla through to the cubital fossa and distal forearm, were methodically exposed and catalogued.

RESULTS

A total of 9 (7.7%) limbs demonstrated anomalous high-origin superficial terminal branches. This comprised two instances of a bilateral superficial ulnar artery, each arising from the axillary artery rather than the expected brachial trunk, and seven instances of a proximally originating superficial radial artery (right side [five] and left side [two]). In every case identified, the variant vessel coursed anterior to the pronator teres muscle. All seven radial artery cases demonstrated a morphologically consistent finding of proximal tortuosity and segmental dilatation, likely related to hemodynamic alterations induced by passage through a fibro-osseous tunnel formed by the bicipital aponeurosis.

CONCLUSIONS

This investigation describes a bilaterally symmetrical axillary origin of the superficial ulnar artery, an exceptionally rare anatomical configuration, along with a proximal radial artery origin concordant with published global estimates. Recognition of these variants is indispensable for the safe conduct of venepuncture, arterial cannulation, cardiac catheterization via the transradial route, and reconstructive or orthopedic procedures involving the upper extremity.