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Anatomy Atlases: Illustrated Encyclopedia of Human Anatomic Variation: Opus II: Cardiovascular System: Veins: Upper Limb

Illustrated Encyclopedia of Human Anatomic Variation: Opus II: Cardiovascular System: Veins

Upper Limb

Ronald A. Bergman, PhD
Adel K. Afifi, MD, MS
Ryosuke Miyauchi, MD

Peer Review Status: Internally Peer Reviewed


In a study of 300 arms, a dorsal venous arch (arcus venosus dorsalis [manus]) was present in 100% of cases. It was found at the level of the middle of the metacarpals and was convex distally.

In 82% of cases, a large ascending vein passed from the center of the convexity to terminate in 65% of cases in the cephalic vein and in 17% in the basilic vein. Judging from this study, the origin of the basilic vein is the ulnar side of the dorsal venous arch, and the basilic is the main venous outlet in 53% of cases. In 47% of cases, a large vein, the oblique, leaves the origin of the basilic to join the cephalic. An accessory cephalic arises proximally from the basilic (parallel with the oblique vein) to join the cephalic in 28% of cases.

On the volar surface, a venous rete is best marked on the thenar, hypothenar, and volar aspects of the wrist; its outlet in 99% of cases is the median antebrachial vein.

The cephalic vein, defined as the vein originating at the radial end of the dorsal venous arch, winds around the radial border of the forearm and passes proximally along the arm to the shoulder region.

In one study, the cephalic vein was found to be of two types. In most cases, a level just distal to the bend of the elbow, the cephalic gives rise to the median cubital vein, which continues in the bicipital sulcus and deltopectoral triangle to its termination. In 16% of cases, it receives the median cubital from the median antebrachial vein.

The termination of the cephalic is almost constant, but two variations were reported. In one case, the cephalic crossed the distal third of the arm to join the basilic. In the other case, the cephalic became continuous with the median cubital and thus terminated in the basilic vein.

The median antebrachial vein may terminate in the basilic (43% of cases). A case of bilateral absence of the cephalic vein has been reported.

In 35 of 44 cases studied, the basilic was found to terminate in the axillary vein without any specific line of demarcation.

The median antebrachial is the main outlet of the volar venous rete. In the arms studied (300), it terminated in the vicinity of the elbow joint as follows: in 43% of cases it terminated in the basilic and in 43% in the median cubital; in 13% it divided to terminate in both the basilic (vena mediana basilica) and cephalic (vena mediana cephalica). In four cases, the median antebrachial vein was absent.

The accessory cephalic (82% of 300 cases) is a vessel running parallel to the median antebrachial. In 39% ofcases, this vessel originated from the distal part of the dorsal forearm, in 28% from the ulnar end of the dorsal venous arch, and in 16% from the cephalic at a point where the cephalic turns around the radial border of the forearm. In 17% of cases, it was either not present or extremely small.

The median cubital is remarkably constant (present in 84% of cases). In 43% of cases studied, it received the median antebrachial as a tributary; in 4% it arose from the cephalic. Its function is to transfer blood from the radial to the ulnar side of the forearm. The median cubital may be doubled (4% of cases), with the extra vessel lying proximal to the main trunk. In four of 300 cases, the cephalic did not give rise to the median cubital vein. In four of 300 cases, only the cephalic and basilic were present, with the median cubital, median antebrachial, and the accessory cephalic being absent. In six of 300 cases, the anastomosis between the cephalic and the basilic by way of a median basilic and a median cephalic was doubled.

The main venous return in the upper limb is by the basilic vein, with all others converging upon it. In 83% of cases, the general arrangement is two longitudinally directed veins, the cephalic and the basilic, connected by the median cubital. In 16% of cases, the cephalic and basilic are connected by the "M-shaped" median antebrachial, median basilic, and median cephalic. In 1% of cases, there are no connections between the cephalic and basilic in the vicinity of the elbow.

Circulation

Image 198

Digital, Palmar Arches

Image 45B

Hand

Image 370

Hand, Forearm, Arm

Image 454


References

Charles, C.M. (1932) On the arrangement of the superficial veins of the cubital fossa in American white and American Negro males. Anat. Rec. 54:9-14.

Petit, -. (1867) Anomalie des artère et des veines du bras. Bull. Médical du Nord de la France 8:237-242.

See the general references cited of the Internal Jugular Vein.

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