Variations of the circumflex humeral arteries: a cadaveric study

Objectives: Surgery is the main treatment option of both anatomical and surgical neck humeral fractures, which could result in damage to the circumflex humeral vessels. Current research studies have found that vascular supply to the shoulder is variable. However, the incidence of these variations and how they can affect the blood supply to the shoulder region is still under investigation. The aim of this study is to identify possible variation patterns of the circumflex humeral vessels. Methods: A total of 10 shoulders (3 males, 2 females; average age of 68.8 years) were dissected in Anatomy, University of Edinburgh, under the regulation of the Human Tissue (Scotland) Act 2006. Each shoulder was dissected, and tissues were removed to identify the axillary artery and its branches. Results: The anterior and posterior circumflex humeral arteries were observed to arise as single branches from the 3rd part of the axillary artery in 70% (n=7) and 80% (n=8), respectively. In one cadaver, the posterior circumflex humeral artery (PCHA) arose from the subscapular artery in one side (10%, n=1) and from the profunda brachii artery on the contralateral side (10%, n=1). In the remaining 10% (n=1), the anterior circumflex humeral artery (ACHA) was found as a branch from the PCHA, with the latter being a direct branch from the 3rd part of the axillary artery. Conclusion: Knowledge and awareness of these variations is essential to not only suspect, diagnose and treat possible complications of common fractures and dislocations in the region, but also to prevent iatrogenic injury.