Miscellaneous variations and anomalies of the arterial pattern were fairly common in upper extremities[1–6]. However, case reports were on the absence of unilateral radial artery, the congenital absence of bilateral radial arteries was rare.
In 1894, Charls first reported an aged male specimen with the absence of radial artery and observed anterior interosseous artery instead in the right upper limb. However, the left radial artery was normal.
In 1966, Kadanoff and Balkansky reported two cases of unilateral radial artery absence, one on the right and the other on the left.
In 1986, Poteat reported the case of a Caucasian female subject with absence of left radial artery. They found that her left upper limb arterial system was developed primitively with the anterior interosseous artery as the chief blood supply to the forearm and hand. Three large terminal branches of the anterior interosseous artery supplied blood to the hand, and a small “superficial ulnar artery” perfused the hand. Radial artery or “superficial radial artery” was not observed arising from the brachial artery or the axillary. Her right side showed an unremarkable pattern of arterial distribution.
In 2001, Cowles found a 44-year-old man with congenital absence of right radial artery from a right upper extremity angiography. He had a normal ulnar artery and a small interosseous artery, and his entire right hand was perfused by only the right ulnar artery. The report, however, did not mention the left upper extremity angiography.
In 2002, Suganthy reported the case of a south Indian female subject with the absence of right radial artery. On the right upper limb, they observed that the brachial artery divided into the ulnar artery and large interosseous artery, whereas the radial artery was not observed. Similar to the previous report, the left extremity was not mentioned either.
In 2006, Yalcin also reported a case of absence of the left radial artery. During the dissection of the right and left upper limbs of a 70-year-old female specimen, combined vascular anomalies were found. On the left arm, the absence of a radial artery with the presence of a lateral inferior superficial brachial artery and large anterior interosseous artery were observed. On the right, a trifurcation of the brachial artery was observed. It branched to the radial, ulnar and one muscular artery at the proximal one-third of the humerus.
In our case, the absence of radial arteries was bilateral and symmetrical, anterior interosseous remained as a dominant artery, while the ulnar arteries were very small in size. Both anterior interosseous artery and ulnar artery supplied blood to the forearm and hand.