Abstract
The brachial artery is the major artery of the upper arm, and it divides into the radial artery and the ulnar artery at the distal site of the elbow. However, there are rare cases of high brachial artery bifurcation that divides near or below the axillary region. We encountered a case of high brachial artery bifurcation that we could diagnose accurately by ultrasonography. The patient was a 68-year-old female. She had a complaint of ulcers in some fingers of the right hand. Ultrasonography revealed high brachial artery bifurcation that divided near the axillary region. Though the blood flow of the radial and ulnar arteries was maintained in the upper arm, both of these arteries totally occluded in the forearm. A slight blood flow signal in the interosseous artery in the forearm could be confirmed. She underwent endovascular therapy. We marked the bifurcation of the radial and ulnar arteries under ultrasound guidance. The access site was the left femoral artery. We advanced the guidewire to the right subclavian artery and the right axillary artery. We identified the origin of the radial artery by the echo-guided marking and angiography, and the guidewire passed through the radial artery occlusion site. We expanded the balloon catheter into the occlusion site and successfully recanalized the blood flow. The right radial artery was subsequently palpable. Identifying the origin of the radial artery by ultrasonography was useful information for the success of the endovascular therapy. It is important to be aware of the high brachial artery bifurcation. Confirming the high bifurcation by ultrasonography in advance helps to decide the access site for the endovascular therapy, making it possible to proceed with the procedure efficiently with the minimum number of devices.
