Dear Editor:

Our patient was a 33 years old man and 15 days before his admission he had a CABG operation in our clinic.After discharging, he smoked heavily and didn't use his drugs properly.In the last 12 hours he had pain,numbness and coldness at left hand and distal part of front arm where radial artery catheterization was performed during CABG.Physical examination showed the 6 signs of acute artery thrombosis ,so an emergent embolectomy was planned.

The exploration with local anesthesia showed duplication of left brachial artery(Figure 1).

Figure 1

Figure 1

Following the arteriotomies of both vessels,abandoned fresh thrombus was provided from radial artery side with 4Fr Fogarty catheter.His all pulses were positive when discarged at postoperative third day and long-term controls were normal.

Comments

Congenital vessel disorders term includes all congenital organic diseases of the vessel system.The development of intraembryoner vasculary structures can be evaluated in 4 stages as;plexus,reticular,truncular and last differentiation.The disorders during the last two stages ends with anomalies.Malformations of the arteries are; agenesis,aplasia,displasia,location anomalies,diameter anomalies, duplication,stricture and ectasies and rarely aneurysms. The total or partial persistence of the superficial arterial segments explains those cases of high origin of either the radial or ulnar arteries as well as the duplications of the brachial artery(₁).

In the study of Rodríguez-Baeza et al; twenty-three cases with variations in the brachio-antebrachial arterial pattern of the human upper limb are reported. According to the artery which showed a variation, 4 groups were recognised: (a) isolated persistence of the median artery; (b) high origin of the ulnar artery; (c) high origin of the radial artery; and (d) duplication of the brachial artery, either with or without anastomosis at the cubital fossa(₁).

It is obvious that accurate information concerning unusual patterns of the arteries in the upper limbs is relevant clinically(₂). Confusion of these unusual arteries with the subcutaneous veins may explain the accidental injection of drugs and distal necrosis of the limb. Knowledge of these variations may facilitate ascending catheterization of the cardiac cavities(₃).

The first step in diagnosis of congenital arterial anomalies is clinical examination.Invasive(especially peroperatively) and non-invasive several methods help in diagnosis. The knowledge of this variation is important since it may be compromised in surgical procedures of the upper limb(₄).

Correspondence to

Doç. Dr. Ufuk YETKİN, 1379 Sok. No: 9,Burç Apt. D: 13 - 35220, Alsancak – İZMİR / TURKEY Tel: +90 505 3124906 , Fax: +90 232 2434848 e-mail: ufuk_yetkin@yahoo.fr