A bifurcated axillary artery in its 2nd part and clinical implications

The case of an axillary artery bifurcating in its second part yielding the superficial brachial and deep brachial arteries in the limbs of a 75-year-old female cadaver is discussed. Unlike other reported axillary artery bifurcation, the case we are reporting is due to a rare branching pattern of branches of the thoracoacromial artery. The four branches of the latter were shared equally between the superficial and deep brachial arteries. The superficial brachial artery direct origins to the deltoid and acromial branches individually, while a clavipectoral trunk shared a common stem of origin with the deep brachial artery, emanating from anterior surface of the axillary artery at the point of bifurcation. The clavipectoral trunk yielded the clavicular and pectoral branches about 2 cm distal to its exiting from the common trunk. Usage of the thoracoacromial artery perforator (TAAP) flap in its pedicle or in the free microvascular variant is an emerging flap for use as a reconstructive option for the head and neck region, often relying on the constancy of the branching pattern of the artery. In the age of increase frequency in the usage of axillary artery in invasive diagnostic and interventional procedures in cardiovascular disease makes knowledge of these patterns of importance to surgeons, interventional cardiologists in guiding the selection of appropriate surgical interventions and in assisting neuroradiologists in the interpretation of images. A “Deep Brachial Steal syndrome” via the clavipectoral trunk and its anastomotic vessels with branches from the subclavian artery is proposed in proximal occlusion occurring at the common origin of the deep brachial and the clavipectoral trunk, our reported deep brachial is smaller than its superficial counterpart, Clinically were the deep brachial inadvertently selected for cannulation, this may present with inadequate inflow or failure even with multiple manipulations of the cannula.