Deep Palmar Arch and Palmar Digital Arteries

37 Deep Palmar Arch and Palmar Digital Arteries

B. Meyer, L. Sonnow

37.1 Deep Palmar Arch

In about two-thirds of all cases, the ulnar artery has two deep palmar branches. The more proximal branch runs to the hypothenar muscles and rarely comes into contact with the deep palmar arch (Fig. 37.2). The additional supply of the interosseous artery to the deep palmar branch is sometimes of practical importance: if the radial and ulnar arteries are obliterated distal to the beginning of the common interosseous artery, the hand can be sufficiently supplied with blood by the anterior interosseous artery (Fig. 37.3). Some case reports of this situation have been published. As both palmar arches supply the same area, it is quite obvious that if one arch is very prominent, the other will be small.¹^–¹⁰

Fig. 37.1 The ulnar artery has one deep palmar branch to the arch (79%). Schematic (a) and DSA (b). 1 Radial artery; 2 ulnar artery; 3 deep palmar arch.

Fig. 37.2 The ulnar artery has two deep palmar branches (13%). Schematic (a) and DSA (b). 1 Ulnar artery with two deep palmar branches; 2 radial artery; 3 deep palmar arch.

Fig. 37.3 The anterior interosseous artery also supplies the deep arch (5%). Schematic.

Fig. 37.4 The deep palmar arch is incomplete (3%). Schematic (a) and DSA after vasodilation (b). 1 Ulnar artery; 2 radial artery; 3 incomplete deep palmar arch.

37.2 Palmar Digital Arteries

According to the usual textbook description, the palmar metacarpal arteries from the deep arch unite with the common palmar digital arteries from the superficial palmar arch. Thus, both arches supply the fingers. However, this is valid for only 30% of all cases, and in a further 10%, the palmar metacarpal arteries anastomose with the proper palmar digital arteries. In the other 60%, there is no functional anastomosis.¹^,⁶^,¹¹^,¹²

Many more combinations of anomalies are possible, for individual common palmar digital arteries can be absent and some metacarpal arteries are not always present. The first palmar metacarpal artery is normally very prominent and has a proper name—the princeps pollicis artery. It also has a branch to the index finger.

Fig. 37.5 Four common palmar digital arteries derive from the superficial palmar arch (77%). Schematic (a) and contrast-enhanced MRA, MIP (b). Radial artery (yellow line); deep palmar arch (yellow asterisk); ulnar artery (red line); superficial palmar arch (red asterisk); common pamar digital arteries (red arrows).

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