Diagnostic and Interventional Imaging (2015) 96, 401—403
LETTER / Cardiovascular imaging
Superficial brachioradial artery:
Multidetector-row computed
tomography angiography
findings in one case
Keywords: Upper limb; Arterial variations; Superficial
brachioradial artery; Multidetector computed tomography
angiography
Various anatomical variations in arterial patterns of
upper limb have been frequently observed either in routine
dissections or in clinical practice. Individual variations in the
branching pattern of the arteries in the arm are important
in practical viewpoints because a large number of vascu-
lar invasive and noninvasive imaging and surgical procedures
are performed in the upper limb [1]. The radial artery having
a high origin proximal to the intercondylar line from either
the axillary artery or brachial artery is called superficial
brachioradial artery [2]. The prevalence of the superficial
brachioradial artery with origin at the level of axillary artery
was found as 1.25—5.9% in the literature [2,3].
Here, we report the present multidetector-row com-
puted tomography angiography (MD CTA) findings of a rare
variant superficial brachioradial artery arising from the sec-
ond part of the axillary artery in the axillary fossa and discuss
its incidence, MD CTA findings, clinical and surgical impor-
tance with a detailed review of the literature. To the best of
our knowledge, MD CTA findings of this rare vascular variant
have not been previously published in the English literature.
Case report
A 19-year-old Caucasian women was admitted to our hospital
because of numbness in both of her hands for approximately
one month. Her medical history was only significant for
smoking for one year. On clinical examination, the pulse
of the left radial artery was weak at the wrist, and this
prompted further investigation to evaluate the left upper
extremity arterial vasculature. Left upper extremity MDCT
angiography of range extending from the aortic arch to the
palmar arch was performed on a 64-row MDCT unit (Aquil-
ion 64; Toshiba, Tokyo, Japan). For three-dimensional image
reconstruction, all acquired data were processed on a sep-
arate workstation (Vitrea 2; Vital Images, Plymouth, Minn,
USA) with multiplanar reformatting, maximum intensity pro-
jection and volume rendering. These images demonstrated
http://dx.doi.org/10.1016/j.diii.2014.11.020
2211-5684/© 2014 Éditions françaises de radiologie. Published by Elsevier Masson SAS. All rights reserved.
a variant branch arising from second part of axillary artery.
Thoracoacromial and lateral thoracic arteries were seen
arising from the second part of the axillary artery, as usual.
About centimeters further distal to the origin of variant
artery, anterior circumflex artery arose from the third part
of the axillary artery. The course of the variant artery was
superficial, running downwards and laterally in the arm,
with giving off only one muscular branch. It had superficial
course in the forearm over the tendon of the snuffbox. The
diameter of the observed branch was smaller than proper
one. Distal portion of the variant artery was also hypoplas-
tic. The proper brachial artery followed its usual course
and continued through the ulnar artery. It also sent off
the radial recurrent artery in front of the radial head. In
the upper third of the forearm, the ulnar artery gave off
the interosseous arteries. Anterior ulnar recurrent artery
emanated from the ulnar artery two centimeters proximal to
the origin of the interosseous arteries (Fig. 1). Our findings
depicted a case of variant artery which should have been
called superficial brachioradial artery.
Discussion
The variations in the arterial anatomy of the upper limbs
occur in up to one in five patients, and the variability of the
arteries in the arm is reported to one in four patients [1].
The high origin of radial artery is the most common
arterial variation observed in the upper limb, showing
the incidence rates between 12.3—16.7% in several studies
[2,4,5]. The case we reported here had superficial brachio-
radial artery, a rare variation which originated directly from
second part of the axillary artery, proximal its usual level of
origin, and coursed over the brachioradial muscle and ten-
don. This also was hypoplastic in the distal portions, which
makes it difficult for the arterial cannulation. The radial
artery having a high origin above the elbow from either the
axillary artery or brachial artery is called superficial brachio-
radial artery. According to Rodriguez et al. [2], brachioradial
artery could arise from proximal segment of brachial artery
65%, distal segment of axillary artery 23% and less frequently
from middle or distal segment of brachial artery in 7.7%
and 3.9%. When the superficial brachioradial artery origi-
nates from the axillary artery (AA) in the axillary fossa, runs
superficially to the median nerve, crosses the cubital fossa,
and in some cases anastomoses with the brachial artery
(BA) through a vessel with a sling-like loop or a rectilin-
ear form at the antecubital fossa. It may also send off some
402 Letter

Figure 1. Three-dimensional volume-rendered (a, b, c) and maximum intensity projection (d, e) CT angiography images showing superficial
brachioradial artery (SBrA) (white arrows) arising from the second part of the axillary artery (long black arrow). From its origin, the SBrA
runs superficial to the brachial artery on the lateral side of the arm, without giving any branch. Its course is seen similar to radial artery in
the forearm. Also, note distal portion of the variant artery is hypoplastic. The proper brachial artery (short black arrows) follows its usual
course. Star points out anterior interosseous artery and the arrowhead indicates the ulnar artery.

muscular (supplying the flexor compartment muscles of arm
and forearm) and cutaneous collateral branches as its curse
[3]. In some cases, this variant artery may give off recur-
rent radial artery as a collateral branch at the level of the
cubital fossa. Origin of the recurrent radial artery in the
presence of brachioradial artery has not been reported so far
by authors of large samples. It commonly originated from the
brachioradial artery followed by brachial and finally from
the anastomosis between the two vessels [2]. Superficial
brachioradial artery classically terminates in the hand by
participating in the formation of the deep palmar arch [2].
DSA is regarded as the gold standard in the evaluation of
vascular structures although its invasive nature significantly
limits its role [6]. The capability of computed tomography
(CT) in providing precise and high-definition vascular details
noninvasively has further improved with the multidetec-
tor CT (MDCT) technology [7]. Multidetector-row scanners
are particularly beneficial for angiographic applications due
to their features of better complete anatomic coverage,
contrast enhancement of the arteries, and longitudinal spa-
tial resolution. The number of MDCT angiographic studies
performed is gradually increasing; therefore, knowledge of
normal and variant anatomic features has become more
important than in the past. CTA is an important diagnos-
tic imaging modality for the evaluation of upper extremity
arterial abnormalities. Upper extremity CTA shows excel-
lent performance in the evaluation of forearm circulation,
whereas the evaluation of the hand remains the realm of
DSA in daily radiology practice. MDCT also allows the radi-
ologist to use image post-processing techniques such as
3D (three-dimensional) VR (volume rendering), MIP (maxi-
mum intensity projection) and multiplanar imaging to better
evaluate the origin and the route of anomalous arteries in
the presence of anatomical variations [8,9]. Imaging of the
normal anatomical structure and its variations through MDCT
contributes to the surgical planning of the patients who
will undergo surgery for various reasons [10]. Preoperative
knowledge of variant anatomy may assist in the selection
of treatment options and surgical planning, which in turn
facilitates surgical dissection and helps avoiding iatrogenic
injury [11].
In conclusion, unusual origin of the radial artery maybe
significant in clinical point of view, especially to vascular
and plastic surgeons. When the superficial artery persists,
it is also more vulnerable and prone for injury at times of
accidents and crush injuries. The knowledge of this type of
variation is important in diagnostic purposes, like cardiac
catheterization, arterial grafting and other angiographic
procedures. MDCT angiography examination of our patient
permitted an accurate and detailed evaluation of this rare
vascular variant. CTA could be considered as the first-line
diagnostic test in case of clinical or ultrasound abnormality.
Disclosure of interest
The authors declare that they have no conflicts of interest
concerning this article.
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Letter
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C. Calisir ∗ , D. Baylam Geleri , L. Celik
Department of Radiology, Eskisehir Osmangazi
University, Faculty of Medicine, Eskisehir, Turkey
∗ Corresponding author.
E-mail address: ccalisir@ogu.edu.tr (C. Calisir)