A Persistent Median Artery Piercing the Median Nerve: A Review and Clinical Implications

Abstract Purpose: This case report documents a rare variation of a persistent median artery. Normally a transient vessel present during embryologic development of the limbs, the median artery typically regresses by the eighth week of life as the radial and ulnar arteries predominate the distal vascular supply of the hand. In a subset of the adult population, this artery remains as a persistent median artery which most often ends in the carpal tunnel or hand without significant vascular dependence. Methods: We report a unique variant of the persistent median artery that perforates the median nerve and contributes a significant portion of the blood supply to the hand. Results: An 84-year-old female cadaver was found bilaterally to have an artery that penetrated the median nerve in the forearm, continued through the carpal tunnel, then joined the superficial arch, giving rise to the common digital artery to the second webspace. It also gave rise to the radialis indicis, the princeps pollicis, and an anastomotic branch to the radial artery. Conclusion: This anatomic variant of a persistent median artery piercing the median nerve, traversing the carpal tunnel, and providing aberrant primary blood supply to a large area of the hand are details clinically relevant to those who treat hand disorders and injuries.