Anastomosis at the level of the elbow joint connecting the deep, or normal, brachial artery with major arterial variations of the upper limb.

Major variations of the principal arteries of the upper limb have long received the attention of anatomists. These variations can be summarised as the presence of 2 main arteries traversing the cubital fossa, a deep (or normal) brachial artery in coexistence with a superficial brachial, radial or ulnar artery. Anastomosis between these arterial trunks at elbow level has been reported in 1–6% of cases as an incidental finding in studies on the major arterial variations of the upper limb (Quain, 1844; Mu$ ller, 1903; Poynter, 1922; Adachi, 1928; McCormack et al. 1953; Wankoff, 1962; Rodrı!guez-Baeza et al. 1995). Only a single report (Ljubomudroff, 1927) has dealt specifically with the anastomosis. The anatomical pattern of the anastomosis has been classified into 2 or 3 types depending on different morphological details. Three types have been described, taking into account its length, calibre and form (Quain, 1844) or the positions of the origin and number of recurrent radial arteries (Ljubomudroff, 1927). Two types have been described on the basis of whether the anastomosis coursed anterior or posterior to the bicipital tendon (McCormack et al. 1953). The aim of this study was to revisit these specific morphological details in a statistically reliable sample in order to catalogue the variations of the anastomosis and to provide an embryological explanation. A total of 79 embalmed cadavers were examined (35 male, 44 female) with an age at death ranging from 57 to 101 y. They had been partly dissected by Cambridge preclinical students in Autumn 1996 and 1997. Statistical comparisons between percentages were performed by the χ# test ; P! 0±05 was regarded as statistically significant. Our results confirm the descriptions of other authors reporting that when there are 2 main arteries in the cubital fossa (a deep, or normal, brachial coexisting with a superficial brachial, radial or ulnar artery), an anastomosis between them may be present (Quain, 1844; Baader, 1866; Charles, 1873, 1875; Mu$ ller, 1903; Forster, 1917; Michelsson, 1920; Poynter, 1920; Ljubomudroff, 1927; Adachi, 1928; McCormack et al. 1953; Weathersby, 1956; Skopakoff, 1959; Wankoff, 1962; Rodrı!guez-Baeza et al. 1995). The anastomosis has been reported with a frequency ranging from less than 1% to 6% (Quain, 1844; Mu$ ller, 1903; Choue!ki-Guttenbrunner et al. 1990; Rodrı!guez-Baeza et al. 1995). In 38 (24%) of the 158 upper limbs studied there were arterial variations (Table 1) connected by an anastomotic branch at elbow level in 14 cases, 9% of the total sample (Table 2). These anatomoses, in relation to the major arterial variations, showed a similar distribution to the values reported by other authors (Table 3). The fact that the superficial radial artery is the most frequently involved in the anastomosis is a direct consequence of the higher frequency of its presence compared with others, as has previously been described (Lippert & Pabst, 1985; Bergman et al. 1988; Tountas & Bergman, 1993). The anastomosis appeared bilaterally in 2 and unilaterally in 10 cases (Table 2). The χ# test (P! 0±05) did not show statistically significant differences between male and female subjects (χ# ̄ 3±25; P ̄ 0±071), or right and left sides (χ# ̄ 2±84; P ̄ 0±093). However, there were statistically significant differences between unilateral and bilateral presence. Those