What are the major arteries in the upper extremity?

Major Arteries of the Upper Extremity

The major arteries of the upper extremity include the subclavian, axillary, brachial, radial, and ulnar arteries, which form the primary arterial supply to the arm, forearm, and hand.

Anatomical Organization

Proximal to Distal Arterial Pathway

1. Subclavian artery

   • Originates from the brachiocephalic trunk on the right and directly from the aortic arch on the left
   • Extends from the sternoclavicular joint to the lateral border of the first rib
   • Gives off branches including:
     • Vertebral artery
     • Internal thoracic artery
     • Thyrocervical trunk
     • Costocervical trunk
     • Dorsal scapular artery

2. Axillary artery

   • Continuation of the subclavian artery as it passes the lateral border of the first rib
   • Extends through the axilla to the lower border of the teres major muscle
   • Divided into three parts by the pectoralis minor muscle
   • Major branches include:
     • Superior thoracic artery
     • Thoracoacromial artery
     • Lateral thoracic artery
     • Subscapular artery
     • Anterior and posterior circumflex humeral arteries

3. Brachial artery

   • Continuation of the axillary artery at the lower border of the teres major muscle
   • Runs down the medial aspect of the arm
   • Major branches include:
     • Profunda brachii (deep brachial artery)
     • Superior and inferior ulnar collateral arteries
     • Nutrient artery to the humerus

4. Radial artery

   • One of two terminal branches of the brachial artery at the cubital fossa
   • Runs along the lateral aspect of the forearm
   • Continues into the hand, forming the deep palmar arch
   • Major branches include:
     • Radial recurrent artery
     • Palmar carpal branch
     • Superficial palmar branch
     • Dorsal carpal branch
     • First dorsal metacarpal artery
     • Princeps pollicis artery
     • Radialis indicis artery

5. Ulnar artery

   • The larger of the two terminal branches of the brachial artery
   • Runs along the medial aspect of the forearm
   • Enters the hand anterior to the flexor retinaculum
   • Major branches include:
     • Anterior and posterior ulnar recurrent arteries
     • Common interosseous artery (divides into anterior and posterior interosseous arteries)
     • Palmar carpal branch
     • Deep palmar branch

Arterial Arches of the Hand

1. Superficial palmar arch

   • Primarily formed by the ulnar artery with contributions from the radial artery in 70% of individuals 1
   • Complete arch present in approximately 70% of hands 1
   • Gives rise to common palmar digital arteries

2. Deep palmar arch

   • Primarily formed by the radial artery with contributions from the deep branch of the ulnar artery
   • More consistent in its anatomy than the superficial arch
   • Gives rise to palmar metacarpal arteries

Anatomical Variations

Several important variations exist in the arterial anatomy of the upper extremity:

1. Superficial palmar arch variations:

   • Complete arch present in 69.2% of right hands and 70.5% of left hands 1
   • Ulnar artery dominance is most common (observed in 47 right hands and 49 left hands in one study) 1
   • Radial artery dominance is rare (observed in only 2 right hands and 1 left hand) 1
   • Codominance occurs in the remaining cases

2. Arterial diameter variations:

   • Mean diameters: brachial artery (4.7 ± 0.6 mm), radial artery (2.8 ± 0.6 mm), and ulnar artery (2.5 ± 0.7 mm) 1

3. High bifurcation of the brachial artery - The brachial artery may divide into radial and ulnar arteries higher than the cubital fossa

4. Accessory brachial artery - An additional branch running parallel to the main brachial artery

Clinical Significance

Understanding the arterial anatomy of the upper extremity is crucial for:

1. Vascular access procedures:

   • The radial artery is increasingly used for angiography and percutaneous coronary interventions 2
   • Complications include thrombosis, hematoma, pseudoaneurysm, arteriovenous fistula, and arterial dissection 2

2. Trauma management:

   • Upper extremity arterial injuries require prompt recognition and treatment
   • Expeditious revascularization (within 90 minutes) significantly reduces amputation rates in traumatic injuries 3

3. Bypass grafting:

   • The radial artery is commonly used as a conduit for coronary artery bypass grafting

4. Arterial disease management:

   • Upper extremity arterial disease can present as arm claudication, rest pain, or ischemic ulcerations 4
   • Atherosclerotic disease is the most common cause of large vessel obstruction 4

5. Sports medicine:

   • Athletes performing repetitive overhead arm motions may develop upper extremity arterial injuries 5
   • These injuries often involve extrinsic compression of the axillary artery or its branches 5

Understanding the normal anatomy and common variations of the upper extremity arterial system is essential for clinicians performing diagnostic and therapeutic procedures, managing vascular trauma, and treating arterial disease affecting the upper limb.