Brachial Artery: Definition, Artery Branches, Traumatism, Thrombosis and Laceration of the Artery

It is an important blood vessel located in the upper arm and is the main provider of blood for the arms and hands.

The brachial artery continues from the axillary artery in the shoulder and travels through the lower arm. Together with the medial ulnar vein and the biceps tendon, it forms the cubital fossa, the triangular fossa inside the elbow.

Beneath the ulnar fossa, the brachial artery divides into two arteries that run down the forearm: the ulnar and the radial arteries.

In some people, this division occurs higher, which causes these arteries to pass through the upper arm.

The other branches of the brachial artery are:

  • The inferior ulnar collateral
  • The deep brachial and the superior ulnar arteries.
  • The pulse of the brachial artery can be felt on the front side of the elbow. This is why blood pressure is measured in this area with a sphygmomanometer (a blood pressure meter) or a stethoscope.
  • The brachial artery originates in the lateral border of the major muscle of Teres and runs through the anterior humerus posterior to the bicipital aponeurosis.
  • The brachial artery has three main braches, of which the Brachi deep is the first and most important.
  • The superior and inferior ulnar collateral arteries are the other two.
  • The branches in the radial and ulnar artery below the antecubital fossa.

Approximately 1 inch below the antecubital fossa, the brachial artery divides into ulnar radial artery, the latter being the largest.

Approximately 1 inch below the origin of the ulnar artery, the common interosseous artery originates and subsequently divides into an anterior artery or volar branch and posterior or dorsal branch.

Trauma to the brachial artery

The brachial vessels are usually injured by both penetrating and blunt trauma, usually associated with humeral fractures . The artery is at greater risk in a proximal third, where it is located next to the humeral axis, and in a distal third near the elbow.

The degree of ischemia after brachial artery injuries depends on whether the lesion is proximal or distal to the Brachi’s deep, there is a 2-fold increase in amputation if the brachial artery was ligated proximal to the deep brachii.

There is anastomosis around the elbow from the inferior ulnar collateral artery to the branches of the ulnar artery, if the collateral circulation is inadequate, the brachial artery obstruction can be catastrophic, leading to the loss of the forearm and the hand.

Ligation of the brachial artery above the profuse brachii artery will result in a loss of the limb in approximately 50% of cases, ligation below the level of the deep brachii will result in the loss of the limb in the brachial artery. 25% of cases.

Thrombosis of the artery

After the brachial artery thrombosis, patients may suffer severe ischemia immediately, but may be asymptomatic due to the collateral extensacirculation on the elbow.

However, surgical repair is recommended even if it is only mildly symptomatic, since a significant number of patients develop subsequent thrombosis if left untreated.

Laceración

Whenever possible, use the saphenous vein as an interpositional graft, there is a high incidence of thrombosis when using polytetrafluoroethylene grafts in brachial repairs, do not use prosthetic grafts in small artery repairs.

Lesions of the brachial or arm veins can be treated by ligation, since edema is rare, with an associated nerve injury, cervical sympathectomy is considered to alleviate the causalgia.

Puncture of the brachial artery

In the antecubital fossa, the brachial artery and the passage of the median nerve below the lacertus fibrosus (bicipital aponeurosis), lacertus fibrosus forms a non-uplifting band, and any hematoma or swelling in the antecubital fossa is poorly tolerated.

Compression of the brachial artery or the median nerve by hematoma can cause severe ischemia or neuropathy or both.

Patients in whom the brachial artery is perforated to take samples or for a line have the risk of developing a hematoma that can compress the brachial artery especially if the patient is receiving anticoagulants.

There are several dozens of reports of incapacitating complications after the puncture of the humeral artery all the necessary punctures of the humeral artery are made above the antecubital fossa to reduce the risk of hemorrhage under the lacral fibrosis.

The artery is identified by palpation in the ulnar fossa, on the medial side of the biceps tendons, and the needle is inserted at the level of the line with the medial and lateral epicondyles avoiding any obvious superficial vein and also the median nerve that is on the medial side of the artery.