1. Variant anatomy and clinical significance of median arteries
Isaac Cheruiyot
3rd year medical student,UON

2. Background Classically: AIA branch 1 Median nerve companion; palm 1
Superficial palmar arch/ digital arteries 1
2 variants: palmar and anterbrachial types2
1. Standring, Rodri-guez-Niedenfuhr et al., 1999

3. Background 2 Displays variation: Prevalence 3 Origin 4 Termination 5
Median artery piercing median nerves 6
3. Aragão et al., Henneberg and George, Patnaik and Paul, Eid et al., 2011

4. Justification Etiology of: Iatrogenic injury 9
carpal tunnel syndrome 7
pronator teres syndrome 8
Iatrogenic injury 9
No reports of MA variations among Kenyans.
7. Balakrishnan et al., Salter et al., 2011

5. Objectives
Broad:
To determine the variant anatomy of the median arteries in a select Kenyan population
Specific:
To determine the:
Prevalence and origin
Pattern of termination
Incidence of median arteries piercing median nerves

6. Materials and methods Descriptive cross-sectional study.
62 upper limbs; forearm and hand dissected.
Prevalence, origin, termination, MA piercing MN noted.
SPSS: paired t test- side difference.
Data: images and tables.

7. Results

8. RESULTS

9. Discussion 2 developmental theories:
a) As primary axial artery of the FA remnant 6
Replaced by RA and UA;
Palmar type= embryological pattern.
b) From primitive capillary plexus 9
Differentiation- distal proximal fashion
9. Varley et al., 2008

10. Discussion: prevalence
Lower than in Brazilians3, South African neonates & adults4.
Higher than in Greeks5 and Indians10.
Basis:
Vs Brazilians (fetuses) and SA neonates:
Diff in age of subjects
Reflects regression with maturity11
Blacks (Ken, SA) Vs non blacks (others):Higher prevalence:
Racial trend?
Genetics- SNP in gene loci? 10
10. Patnaik and Paul, Walker et al., 2013

11. Discussion 2 MA vs CTS: MA vs PTS: Relevance: Atherosclerosis12
Thrombosis13: oral contractive/trauma/infxn
Aneurysms? 14
MA vs PTS:
High prevalence of MA piercing MN,
Pulsatility?
Relevance:
Ddx in CTS/PTS 12, 13,5,6
Surg mx (avoiding iatrogenic injury) 3,4
12. Balakrishnan et al., Salter et al., Gassner et al.,2012

12. Discussion 3 Origin of MA:
Highly variable: CIA (most common), AIA, UA.
Agreement with previous authors.3,4,5
Sacrificed in RA/ UA flaps?1, 15
Possible hand ischemia? 15
15. Acarturk et al., 2008

13. Discussion 4 MA termination: SPA/ digital arteries3,4,6.
Significant source of blood supply to hand 16.
Source of unexpected bleed in hand surg procedures 7.
Iatrogenic injury= post-op morbifity eg hand ischemia?.
16. Natsis et al., 2009

14. Conclusion Our results: add on to existing accounts on MA anatomy.
High prevalence of MA and MA piercing MN.
Ddx in CTS/PTS diagnosis and Mx.
Prevent clinical sequel of MA injury.

15. Sample references
Acarturk, T.O., Tuncer, U., Aydogan, L.B. and Dalay, A.C., Median artery arising from the radial artery: its significance during harvest of a radial forearm free flap. Journal of Plastic, Reconstructive & Aesthetic Surgery, 61(10):5-8.
Aragão, J.A., da Silva, A.C.F., Anunciação, C.B. and Reis, F.P., Median artery of the forearm in human fetuses in northeastern Brazil: anatomical study and review of the literature. Anatomical science international, 92(1):
Balakrishnan, C., Smith, M.F. and Puri, P., Acute carpal tunnel syndrome from thrombosed persistent median artery. The Journal of emergency medicine, 17(3):
Eid, N., Ito, Y., Shibata, M.A. and Otsuki, Y., Persistent median artery: cadaveric study and review of the literature. Clinical Anatomy, 24(5):
Gassner, E.M., Schocke, M., Peer, S., Schwabegger, A., Jaschke, W. and Bodner, G., Persistent median artery in the carpal tunnel color Doppler ultrasonographic findings. Journal of ultrasound in medicine, 21(4):