Ulnar artery

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The Clinical Significance of Ulnar Artery Morphology in Artificial Arterial-Venous Fistula for Hemodialysis

The Clinical Significance of Ulnar Artery Morphology in Artificial Arterial-Venous Fistula for Hemodialysis

This study involves the dissection of 34 cadavers (14 female and 20 male) with a total of 68 upper limbs (34 right, 34 left) and an age range of 37–96 years. In each dissection, the ulnar artery was exposed. The origin of the ulnar artery (Figure 1) and its internal and external diameters were examined using a vernier calliper, ruler, and protractor. For the ulnar artery, the measurements of the means and associated standard deviations (mm) of the external and internal diameters and thickness of the ulnar artery at its origin, at the level of the common interosseous artery origin and at the wrist in males and females as well as in entire cases were taken. The angle of origin of the ulnar artery from the brachial artery was measured in the cubital fossa along with its internal and external diameter. An imaginary line drawn along the brachial artery was used as a reference point to measure the angles. The angle of the radial artery was measured first followed
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HIGH ORIGIN OF ABERRENT ULNAR ARTERY – A CASE REPORT .......

HIGH ORIGIN OF ABERRENT ULNAR ARTERY – A CASE REPORT .......

Variation in upper limb vessels are common and knowledge of these variations is important as for as orthopedic surgeons, vascular surgeons, plastic surgeons, radiologists and anatomists. High origin of ulnar artery is a rare variation where the artery takes origin either from axillary artery or from brachi- al artery in axilla or arm correspondingly and runs a superficial course in the forearm and ends by participating in the formation of superficial and deep palmar arch in the hand. During routine anato- my dissection for undergraduate students we found a case of high origin of unilateral superficial ul- nar artery (SUA), which took its origin from axillary artery in left upper limb of a 70 year old male cadaver. In the present journal review of literature regarding anatomy, embryology, & clinical signi- ficance of anomalous artery is discussed.
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A rare variant of the ulnar artery with important clinical implications: a case report

A rare variant of the ulnar artery with important clinical implications: a case report

The ulnar artery can present several anatomical varia- tions. In this paper we describe a bilateral superficial brachioulnar artery that, instead of travelling over the anterior aspect of the forearm muscles, as is usually the case in this variant of the ulnar artery, coursed under the palmaris longus muscle, before reaching the lateral aspect of the flexor carpi ulnaris muscle and becoming part of the ulnar neurovascular bundle. This rare variant of the ulnar artery should always be born in mind when addressing the vessels of this region clinically.
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High origin of a superficial ulnar artery arising from the axillary artery: anatomy, embryology, cinical significance and a review of the literature

High origin of a superficial ulnar artery arising from the axillary artery: anatomy, embryology, cinical significance and a review of the literature

The superficial ulnar artery (SUA) is defined as an ulnar artery which branches from the axillary, brachial or superficial brachial arteries, courses over the fore- arm flexor muscles and coexists with a brachial or su- perficial brachial artery that branches into either the radial and common interosseous arteries or, less fre- quently, into the radial and ulnar arteries [19, 31, 32]. According to the typical arterial pattern, the sub- clavian artery becomes the axillary artery as it cross-

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A case of congenital aneurysm of the ulnar artery of the palm

A case of congenital aneurysm of the ulnar artery of the palm

Congenital aneurysms of the palm are uncommon in the pediatric population compared to aneurysms in adults. A seven-month-old boy presented with a true aneurysm of the ulnar artery with reconstruction with surgical excision and end-to-end microvasculer anastomosis using a superficial vein of the dorsal foot. To our knowledge, there have been only 15 reports of congenital aneurysms of the palm.

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Brachial artery, its Branching Pattern and variations with its clinical applications

Brachial artery, its Branching Pattern and variations with its clinical applications

arterial trunk runs superficial to the nerve, this is the "arteria brachialis superficialis". It may replace the main trunk, or it may be accompanied by an equally important, less important, or more important trunk running parallel and deep to the median nerve in the normal position. In these cases the superficially placed vessel may continue as the radial or more rarely as the ulnar artery. He further subdivided the "arteria brachial superficialis into superior, medial and inferior according to its point of origin for the main arterial trunk. The point of origin may be from the axillary, most frequently it is from the upper part of the brachial, but a "superficial brachial artery" may also arise from the lower part of the brachial artery nearer the elbow.
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Invasive and Non-Invasive Cardiology | Peer Reviewed Journal

Invasive and Non-Invasive Cardiology | Peer Reviewed Journal

TRA access has been shown to reduce mortality and adverse events even in high-risk patients [22,23] with lower incidence of vascular complications than conventional transfemoral one [24]. The reduced discomfort and early mobilization [25,26] make it particularly required by hospitalized population, becoming the default access site in our catheterization laboratory. However, TRA is not free from challenges and complications, partly depending on the experience of the interventional cardiologist, which range from trivial radial artery spasm to RAO [27]. The reported incidence of RAO varies from 0.8% to as high as 38% in the published data [28-32]. This complication run often quiescent, because of the dual vascular supply of the hand from the palmar arch, but limits the future use of the vessel for PCI, as a conduit for bypass grafting, or fistula formation in hemodialysis patients. Baseline patient characteristics [33] (body mass index, diabetes) as well as procedural variable [34,35] (sheath size, anticoagulants) may influence RAO. Bernat et al. proposed post-procedural homolateral ulnar artery compression as an effective method for the treatment of acute RAO, particularly in patients with very- low and low-dose of heparin [36]. Other techniques based on the application of a continuous ulnar compression during the patent hemostasis technique, were also proposed with the aim to reduce RAO’s rates: in a randomized controlled trial, the ipsilateral ulnar artery compression at the Guyon’s canal obtained by placing a cylindrical composite and a circumferentially applied Hemoband, was shown to reduce
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Retained Intrauterine Foetal Bones: A Review of Literature

Retained Intrauterine Foetal Bones: A Review of Literature

The SPA is the center of attraction for most of the procedures and traumatic events in the hand. The hand surgeon needs to refer to the existence and healthy function of the arch before surgical procedures such as, arterial repairs, vascular graft applications and free and/or pedicled flaps depending on radial or ulnar artery in order to maintain or not to harm the perfusion of the hand and digits.

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Thrombosis of the brachial artery – a rare and devastating complication after a simple closed posterolateral elbow dislocation

Thrombosis of the brachial artery – a rare and devastating complication after a simple closed posterolateral elbow dislocation

The  elbow joint is surrounded by rich collat- eral arterial blood supply: the radial artery con- nects to the proximal part of the brachial artery through the anterior branch of the deep brachi- al artery, and the ulnar artery has its connection through superior and inferior collateral ulnar ar- teries (11). Because of this feature, in up to 10% of cases, pulsations of ulnar and radial arteries are present despite blood flow disruption in the bra- chial artery (3, 5, 7). In such cases, the physician should be alerted to excessive swelling at the joint and the presence of median nerve palsy. Surgical treatment with a saphenous vein graft or direct su- ture should be preferred even in the cases when the neurovascular status is maintained to prevent further claudication and cold intolerance (7, 12). However, in our opinion, conservative treatment would be possibly more beneficial for low-de- manding patients. As a proof, it is unknown how many patients have latent brachial artery injury after a  closed dislocation and maintained neu- rovascular status. In such a  case, angiography is mandatory to differentiate thrombosis from rup- ture of the brachial trunk. If a rupture is present, swelling and large haematoma could interfere with collateral blood supply, and surgical exploration is indicated despite the social status of the patient.
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As for larger studies, consisting of the detailed descrip- tion of many specimens of the upper limb arterial trunks as a whole, no relevant data can be found, except the above mentioned study made by Quain [19]. Müller studied both fetuses and adults and observed only two cases of the SBMA in 1903. Incidence stated by him is 0% in adults (0/100) and 1% in fetuses (2/200) [28]. A summary of similar variations comes from the work of Poynter (1922) who classified the variations of the BA into four groups. The Group II.1 represents the case when there are two main arterial trunks in the arm (“doubled BA”) and the variant superficial brachial artery continues as the ACNM or the common interosseous artery. No detailed data on the superficial or deep course of the ABM are stated but it includes several references (although most of them are not in context) [40]. Dubreil-Chambardel classified the origin of the ACNM into 10 types in 1926, the types VIII-X includ- ing the origin form the BA (2% out of all cases) but the real ABM can be related only to type IX [30]. Lieffring in 1924 only summarized from the above-stated case reports, and himself reported only the ACNM [41]. Adachi termed this variant as “arteria antebrachialis superficialis mediana” and summarized 8 cases (Nr. 6-14) from 410 dissected limbs of Japanese, all uni- lateral (Table 3). The last case (No. 14) cannot be considered a true ABMS because the variant artery, stemming from the AB in the middle of the arm, bifurcates superficially in the cubi- tal fossa into the ACNM and the ulnar artery: That is why it should be considered as the brachioulnomedian artery and we have excluded it from the summary. The numbers reported by Adachi (1.7%) surpass the incidence reported in individual cases in the Caucasian race [42]. McCormack recorded in 1953 no such variant in his extensive study on 750 limbs [34]; neither did Keen in 1961 in his study of 284 limbs of different races [43].
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Major Complication Secondary to Percutaneous Radial Artery Catheterization in the Neonate

Major Complication Secondary to Percutaneous Radial Artery Catheterization in the Neonate

Suggested sites for these lines have in- cluded the umbilical artery, temporal artery, radial artery, posterior tibial artery, dorsalis pedis artery, and the ulnar artery.. It is well ap[r]

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Superficial brachial artery: a possible cause for idiopathic median nerve entrapment neuropathy

Superficial brachial artery: a possible cause for idiopathic median nerve entrapment neuropathy

This study presents three cases with unilateral presence of the SBA encountered during routine undergraduate dissection at the University of Johannesburg. Case 1 — SBA divided into radial and ulnar arteries. Brachial artery (BA) terminated as deep brachial artery. Case 2 — SBA continued as radial artery (RA). BA terminated as ulnar artery (UA), anterior and posterior interosseous arteries. Case 3 — SBA continued as UA. BA divided into radial and common interosseous arteries. Arteries that take an unusual course are more vulnerable to iatrogenic injury du- ring surgical procedures and may disturb the evaluation of angiographic images during diagnosis. In particular, the presence of SBA may be a course of idiopathic neuropathies. (Folia Morphol 2017; 76, 3: 527–531)
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Anatomical variations of the superficial and deep palmar arches

Anatomical variations of the superficial and deep palmar arches

The use of radial arteries as an arterial bypass conduit is an invasive procedure which is becoming popular among various medical centres. The greatest risk associated with harvesting the radial artery is ischaemia of the soft tissues of the hand. In this study we dissected 200 hands derived from 100 formalin-fixed cadavers in order to identify arterial patterns that will allow safe removal of the radial artery for use in bypass procedures. A complete superficial palmar arch (SPA) was found in 90% of the cases and divided into 5 types, while the remain- ing 10% possessed an incomplete palmar arch. Types of SPA are designated by the letter S. In type S-I (40%), the SPA is formed by anastomosis of the superfi- cial volar branch of the radial artery to the ulnar artery. Type S-II (35%) is formed entirely of the ulnar artery. Type S-III (15%) is formed by anastomosis of the ulnar and median arteries. Type S-IV (6%) is formed by anastomosis of the ulnar, radial, and median arteries and Type S-V (4%) is formed by a branch of the deep palmar arch (DPA) communicating with the SPA.DPA was identified in all speci- mens and classified into three types, all designated by the letter D. Type D-I (60%) is formed by anastomosis of the deep volar branch of the radial artery and the inferior deep branch of the ulnar branch. Type D-II (30%) is formed by anas- tomosis of the deep volar branch of the radial artery and the superior deep branch of the ulnar artery. Type D-III (10%) is formed by anastomosis of the deep volar branch of the radial artery with both deep branches of the ulnar artery. This data could provide an important source of information for vascular surgeons harvesting radial arteries.
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The incidence of a superficial arterial pattern in the human upper extremities

The incidence of a superficial arterial pattern in the human upper extremities

The incidence of superficial arteries was studied in 68 (38 right and 30 left) upper extremities. One right limb of an adult male presented a superficial arte- rial pattern (2.63%, total 1.47%) resembling a superficial brachio-ulno-radial artery (SBUR). The median nerve crossed the superficial brachial artery (SBA) from the posterior to the medial side and again posterior to the same at the cubital fossa. The superficial brachial artery divided into superficial radial and superficial ulnar arteries, which coursed distally superficial to the muscles but deep to the deep fascia. The superficial radial artery passed deep to the extensor tendons of the thumb. The superficial ulnar artery gave only muscular branches in the forearm. The superficial radial artery gave origin to the radial recurrent artery and the common interosseous trunk. The latter gave origin to a palmar type of median artery, muscular branches, and an artery that divided into ante- rior and posterior ulnar recurrent arteries. It also gave origin to the anterior and posterior interosseous arteries. The latter provided the interosseous recurrent artery and a branch that coursed towards the olecranon process of the ulna. The knowledge of this variation is important since it may be compromised in surgical procedures of the upper limb.
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Study the Anatomical Variations of the Posterior Interosseous Artery and Its Clinical Applications

Study the Anatomical Variations of the Posterior Interosseous Artery and Its Clinical Applications

The septo- cutaneous island flap based on the posterior interosseous Artery raised on the posterior aspect of forearm originally described by Zancolli and Angrigiani in 1985 has widespread application in reconstruction of soft tissue defects of the dorsum of hand, wrist and first web space. The major advantage of this flap is that it does not require sacrifice of any vessel essential for perfusion of the hand. Both the radial artery forearm flap and ulnar artery forearm flap although popular are fraught with disadvantages. Both flaps are based on the integrity of the palmar arches and a major artery for the vascular supply of the hand is sacrificed by flap harvesting. Suominen et al 25 studied 18 patients after
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Comparison between Distractor Application on Both Radial & Ulnar Side and Radial Side Only for Fracture Distal Radius with Ulnar Styloid Fracture

Comparison between Distractor Application on Both Radial & Ulnar Side and Radial Side Only for Fracture Distal Radius with Ulnar Styloid Fracture

After obtaining ethical clearance from the institutional Ethics committee, study was conducted among the study populations after obtaining written informed consent in accordance with the Ethical standards of the 1964 Dec- laration of Helsinki as revised in 2000. The relevant in- formation collected by using a pre-designed proforma including history, general and systemic examination find- ings. Initial radiograph of the wrist joint was conducted besides routine pre anesthetic investigations. The 32 pa- tients were divided in to two groups, 16 in each. The pa- tients under group A were treated by distractor applica- tion on both the radial and ulnar sides, while group B were treated with distractor application on the radial side only. The patients were followed up with radiographs at 2 weeks apart. Distraction was done in only those with persistent deformity under image intensifier. The dis- tractor was maintained for 6 weeks on an average till bony union was evident on skiagram. Following removal of the distractor, the patients were advised active and passive range of motion exercises of the wrist joint. Pa- tients were followed up at every 2 weeks. Radiographs were obtained again at the end of 12 weeks for compari- son. The number of patients with restoration of radial length (within 3 mm of the contralateral side), radial an- gle (<5 degrees), intracarpal step-off (<2 mm) and pal- mar tilt (0 degrees) in each group were evaluated and Fisher’s exact test was performed. The two tailed P-value was calculated and both the groups were statistically compared.
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Unstable Distal Radius Fractures Treated by Volar Locking Anatomical Plates

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screws. Plating allows direct visualization of fracture fragments and restoration of the anatomy, decreased morbidity by allowing early mobilization, and early return of wrist function. Locking plates address intra-articular and metaphyseal comminution and are very helpful in osteoporotic fractures preventing late collapse of fracture fragments. Biomechanical studies comparing volar fixed- angle locking plates with that of conventional dorsal plates report volar fixed-angled plates to be superior in terms of their strength. Dorsal plating of distal radius has not gained popularity due the fact that, inspite of dorsal plating, the volar collapse of fracture occurred [20]. Complications associated with plating include risk of infection as compared to closed procedures, tendon irritation or rupture. These may warrant implant removal in some cases. DRUJ instability was previously recognized as a poor prognostic factor in the management of distal radius fractures. However, studies suggest that anatomically reduced and rigidly fixed distal radius fractures with locking plates have no significant difference in the final functional outcome between patients treated with and without ulnar styloid fractures, despite the degree of displacement and the location of the fractures [21]. In our study, seven (13.20%; 2 23-A3,1 23-B2,1 23-B3, 1 23-C2 and 2 23-C3) patients, diagnosed to have DRUJ instability intraoperatively underwent additional radio-ulnar K-wire fixation. The K-wire was removed in the Out-Patient Department after 4 weeks. These patients had reduced pronation at 6 weeks of follow-up but there was no difference compared to the non-fixed group at the end of 3 months. DRUJ fixation had no negative impact on the outcome of the study at the end of 1 year follow-up.
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Clinical Reasoning: A 65-year-old man with asymmetric weakness and paresthesias

Clinical Reasoning: A 65-year-old man with asymmetric weakness and paresthesias

Nerve conduction studies revealed conduction block in the forearm of the bilateral ulnar and left median nerves and mildly slowed conduction velocity of the left median and ulnar motor nerves (figure and tables 1 and 2). The left su- perficial peroneal sensory response was absent. The left sural, radial, and right ulnar sensory responses showed mildly re- duced amplitudes and conduction velocities (table 1). F-wave latencies were prolonged in the left ulnar nerve (table 1). Needle EMG showed widespread active denervation in upper and lower extremities on the left side and abnormal sponta- neous activity (fibrillation potentials and positive sharp waves) from cervical and lumbar paraspinal muscles (table 1). Questions for consideration:
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The impact of extended electrodiagnostic studies in Ulnar Neuropathy at the elbow

The impact of extended electrodiagnostic studies in Ulnar Neuropathy at the elbow

Differential diagnosis involves many diseases concerning the spinal cord, cervical roots and other peripheral entrap- ment sites. Consequently, clinical findings and tests in our opinion are not sufficient to make a qualified diagnosis of UNE. In the literature most surgeons advocate electrodiag- nosis for UNE [24], but others prefer clinical testing with- out electrodiagnosis [31]. Especially before surgery one should produce direct evidence for entrapment of the ulnar nerve at the elbow and single out other possible eti- ologies. Electrodiagnosis before surgery is also recom- mended in order to have a valid baseline for further studies on patients with residual symptoms after surgery. Patients might be in doubt whether to have an operation or not, and results from a nerve conduction study can help him/her to decide. Nonoperative management can also be successful, especially in patients with symptoms only [32].
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Arthroscopic reduction of an irreducible distal radioulnar joint in Galeazzi fracture dislocation due to a fragment of the ulnar styloid: a case report

Arthroscopic reduction of an irreducible distal radioulnar joint in Galeazzi fracture dislocation due to a fragment of the ulnar styloid: a case report

Kikuchi et al. reported a case of Galeazzi fracture-dis- location with an irreducible DRUJ due to entrapment of a fragment avulsed from the fovea of the ulna [4]. The fracture of the radius was treated with open reduction and internal fixation, but the ulnar head could not be re- duced. Therefore, the ulnar head was exposed through a dorsal incision in order to reduce the DRUJ. Suspected mechanism of injury in our case was as follows: First, metaphyseal fracture of the radius occurred during a high-energy bicycle race. Second, after the radius was shortened, the dislocation of the DRUJ occurred, and it was accompanied by ulnar styloid fracture. The fragment of the ulnar styloid remained in its original position rela- tive to the radius. Third, the doctor who treated it earlier could not manually reduce the ulnar styloid, but achieved reduction of the radius to some extent. Thus,
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