High Bifurcation of the Brachial Artery: A Cadaveric Case Series Highlighting Anatomical Variations and Clinical Implications

Background: The brachial artery usually ends in the cubital fossa, having divided into the radial and ulnar arteries. The variations of the origin and branching pattern, especially the high bifurcation, are of great clinical and surgical significance. This study aimed to demonstrate the four cases of the high bifurcation of the brachial artery according to the Rodríquez-Niedenfuhr classification. Material and Methods: The anatomical variation study was performed on 40 limbs dissected from 20 formaldehyde-fixed upper limbs. The standard neurovascular dissection of the upper limbs, cubital fossa and forearm was performed. The morphological measurements of the variation specimens were taken in situ using a digital vernier caliper. Measurements included the distance from the bifurcation point to selected anatomical landmarks and the external diameter of the arteries at their origin. Results: In total, four cases (cadavers) of high bifurcation of the brachial artery were discovered in twenty cadavers dissected during the research. Thus, the prevalence rate appeared to be 20%. Out of these four cases, three cases (75%) were found on the unilateral side, and one case (25%) – on the bilateral sides. In other words, 5 out of 40 dissected limbs showed variation anatomy in relation to this branching pattern, or 12.5%. Based on the Rodríguez-Niedenführ classification, in all four cases, a brachioradial and brachioulnar arterial pattern were identified. Conclusion: High-level bifurcation of the brachial artery was a frequent finding in this study. Moreover, this variation was associated with the alteration of the usual relationships of the brachial artery with the surrounding structures.

Keywords: Anatomical variation; Clinical anatomy; Upper limb; Vascular anatomy; Cadaveric anatomy.