A Bilateral Aberrant Suprascapular Artery Associated with Neurovascular Structures Multiplication

A Bilateral Aberrant Suprascapular Artery Associated with Neurovascular Structures Multiplication | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article A Bilateral Aberrant Suprascapular Artery Associated with Neurovascular Structures Multiplication Maria Piagkou, George Tsakotos, Dimitrios Chytas, Trifon Totlis, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-2460765/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 10 May, 2023 Read the published version in Surgical and Radiologic Anatomy → Version 1 posted 7 You are reading this latest preprint version Abstract Purpose The current report describes a rare bilateral suprascapular artery (SPSA) of ectopic origin. Coexisted neurovascular aberrant structures were also identified and considered from a clinical point of view. Methods The variants were identified in a 91-year-old formalin-embalmed male cadaver, derived from a body donation program after a signed informed consent. Results In the left axilla, the SPSA emanated from the 1 st part of the axillary artery, coursed between the brachial plexus lateral and medial cords, accompanied by the suprascapular nerve, and passed below the superior transverse scapular ligament. Ipsilateral coexisted variants were the lateral thoracic artery multiplication, the subscapular artery division into multiple branches, and the musculocutaneous nerve and the median nerve lateral root duplication. In the right supraclavicular area, a SPSA duplication was identified. The main artery emanated from the thyrocervical trunk in common with the transverse cervical artery and the accessory one from the dorsal scapular artery. Both SPSAs coursed over the superior transverse scapular ligament, while the suprascapular nerve ran below the superior transverse scapular ligament. Conclusions The SPSA atypical origin, course and location is clinically important, as the artery is usually identified and ligated during surgery. The SPSA atypical course below the superior transverse scapular ligament may be a risk factor for the suprascapular nerve compression. suprascapular artery variation origin axillary artery subclavian artery lateral thoracic artery subscapular artery Figures Figure 1 Figure 2 Introduction The axillary artery (AA) typical, six-branches’ pattern is encountered in a quite low prevalence (27%) [ 8 ], fact that highlights the wide AA variability. The typical pattern includes the superior thoracic artery (occasionally absent), the thoracoacromial artery, the lateral thoracic artery (LTA, occasionally multiplied), the subscapular artery (occasionally fused with adjacent arteries), the anterior and posterior circumflex humeral arteries (occasionally fused) [ 18 ]. Supernumerary branches may also occur isolated or fused into common trunks or emanating in common with the constant vessels [ 8 ]. Rarely, some of the subclavian artery branches may originate from the AA (the so-called ectopic branches). Such an example is the ectopic (proximal or distal) origin of the suprascapular artery (SPSA), quite rarely [ 7 , 14 ]. The SPSA typically emanates from the thyrocervical trunk, independently or by a common trunk with the transverse cervical artery (75%) [ 18 ]. Usually, it courses inferior to the transverse cervical artery, across the anterior scalene muscle and the phrenic nerve, behind the internal jugular vein and the sternocleidomastoid muscle. Thereafter, it continues laterally behind the subclavius muscle, crossing the subclavian artery and brachial plexus. The SPSA usually passes over the superior transverse scapular ligament and reaches the supraspinatus fossa of the scapula. The suprascapular vein that accompanies the artery usually lies ventral and superior to the SPSA [ 18 ]. The SPSA may occur with a variant origin, course, and termination and coexist with other variants from the adjacent structures. The current report describes a rare bilateral aberrant origin of the SPSA from the AA 1st part (left side) and from the dorsal scapular artery (right side) identified after a careful dissection of a formalin-fixed 91-year-old male donated cadaver. The SPSAs of atypical course and termination, coexisted with adjacent neurovascular structures’ variants. Case Report During dissection of a formalin-embalmed 91-year-old male donated cadaver, a bilateral aberrant SPSA was identified. The subject donated his body before death ( from cachexia due to the Alzheimer disease ) to the Anatomy Department of the Medical School of the National and Kapodistrian University of Athens (NKUA), through the “Anatomical Gift Program” after a written informed consent. Details of the medical record of the subject were unknown. In the left axilla , at the 1st rib inferior border, the AA gave off an aberrant SPSA (atypically coursing between the brachial plexus lateral and medial cords, posterior to the lateral and medial pectoral nerves’ connection) and a superior thoracic artery. The aberrant SPSA and the suprascapular nerve coursed below the superior transverse scapular ligament. The suprascapular vein ran over the superior transverse scapular ligament and emptied into the external jugular vein (Fig. 1 A). In the right supraclavicular area , a SPSA duplication was identified. The main SPSA typically emanated from the thyrocervical trunk by a common trunk with the transverse cervical artery, and coursed anterior to the brachial plexus lateral cord. At the lateral third of the clavicle, it crossed with the suprascapular nerve and passed over the superior transverse scapular ligament, accompanied by the suprascapular vein and the accessory SPSA. The accessory SPSA originated from the dorsal scapular artery, that atypically originated from the transverse cervical artery. The two SPSAs anastomosed, 1.8 cm proximal to the superior transverse scapular ligament. The suprascapular nerve arose from the brachial plexus upper trunk, ran inferior to the SPSA and passed below the superior transverse scapular ligament (Fig. 1 B). Coexisted variants In the left axilla, two LTAs (the 1st and 2nd ) emanated from the AA 2nd part. The subscapular artery from the AA 3rd part, gave off the 3rd, 4th and 5th LTAs, the thoracodorsal artery, the circumflex scapular artery, muscular branches (to the lower part of the subscapularis and the teres major muscle) and the posterior circumflex humeral artery. The anterior circumflex scapular artery directly emanated from the AA. The single intercostobrachial nerve coursed through the 3rd and 4th LTAs and the long thoracic nerve descended posterior to them. A MCN and a median nerve lateral root duplication were also identified. The main MCN had a typical course and branching pattern and the accessory one innervated the coracobrachialis and the short head of the biceps brachii muscle (Figs. 1 A, 2 A, 2 B). Overall, the cadaver presented no obesity or muscle atrophy. No signs of pathological conditions, trauma, or earlier surgery in the cadaver’s upper limbs were identified. Discussion The current report describes a rare bilateral aberrant SPSA originating from the AA 1st part (left side) and from the dorsal scapular artery (right side, the accessory vessel from the duplicated SPSA). The SPSA variant origin from the subclavian artery is more common (10 and 12%) [ 18 , 20 ], compared to the rare axillary origin (incidence ranging between 1.6% and 3.8%) [ 12 , 14 , 17 ]. Naidoo et al. [ 14 ] reported an axillary origin of the SPSA (from the 1st part in 2% bilaterally, from the 2nd part in 5% unilaterally). Other SPSA unusual origins include the internal thoracic artery (1–11%), the inferior thyroid artery (3.84%) [ 7 ], the costocervical trunk (1%) [ 17 , 18 , 20 ], the subclavian artery 1st part (1–2 mm lateral to the internal thoracic artery, a high origin) [ 5 ] and the dorsal scapular artery [ 17 ]. Bilateral aberrant origins from the AA 3rd part (distal origins) are rare [ 7 , 11 , 16 ], as well as the SPSA distal origin from the subscapular artery, with the artery passing inferior to the superior transverse scapular ligament [ 1 ]. The subclavian origin of the SPSA, proximal to the internal thoracic artery, is challenging to dissect, and may cause postoperative ischemia [ 6 ]. Ferreira [ 7 ] described a SPSA duplication, with the accessory SPSA forming an anastomosis with the main SPSA, as in the current case. Moreover, in the current case, the SPSA atypically coursed at the left side between the brachial plexus lateral and medial cords, while at the right side its course was typical, anterior to the brachial plexus, like in the majority of the published cases (71%) [ 3 ]. The SPSA atypically courses between the brachial plexus upper and middle trunks in 28% and posterior to the brachial plexus in 1% [ 3 ]. The SPSA typically passes over the superior transverse scapular ligament [ 18 ]. Its course inferior to the ligament is rare (2.5%) [ 19 ]. In the present case both suprascapular artery and nerve terminated inferiorly to the superior transverse scapular ligament, at the left side. Developmentally, the main vessels derive from a primary capillary plexus. Under prevailing conditions, some vessels enlarge and reach their definite form and others regress [ 2 ]. During that process, the variant branching pattern, including both the variant origin and/or course, may appear. The current report highlights the coexistence of a bilateral aberrant SPSA of atypical course and termination (unilaterally), a SPSA duplication (unilaterally), with five LTAs, a subscapular artery divided into multiple branches, a double MCN and a double lateral root of the median nerve (unilaterally). In addition, the ectopic branches coexisted with the absence of other AA branches, such as the superior thoracic artery. The accessory LTAs emanated from both the AA and the subscapular artery. In the literature, variant LTA origins include the thoracoacromial artery (67.62%), the AA (17.02%), the thoracodorsal artery (5%) and the subscapular artery (3.93%) [ 10 ]. The LTAs multiplication (3.09%), as well as its variant origin are clinically important [ 10 ] since the artery should remain intact during neck and breast surgery [ 10 ]. The formation of common trunks among the AA branches is quite uncommon. The subscapular artery has been identified to originate in common with the LTA (28.7%), with the posterior circumflex humeral artery (15.2%), and with the LTA and posterior circumflex humeral artery (4.7%) [ 8 ]. In the present study, the accessory LTAs emerged both from the AA and the subscapular artery, similarly to Panagouli et al. [ 15 ] case, in which the LTA emerged from the subscapular artery. The abnormal origin, course and termination of the AA branching pattern may cause confusion in angiographic studies and complicate a surgery [ 3 ]. In the current study, the main MCN had a typical course and branching pattern, while the accessory one innervated both coracobrachialis and the biceps brachii short head. In Miller and Trelease study [ 13 ], the duplicated MCN supplied the muscles of the anterior arm compartment and provided lateral antebrachial cutaneous innervation. The SPSA is clinically important during surgery in the anterior neck and supraclavicular region and must be identified and ligated [ 9 ]. The artery’s injury may cause micro-embolic events at the suprascapular nerve small vessels leading to neuropathy [ 7 ]. The knowledge of the SPSA variants is clinically important in arthroscopic suprascapular nerve decompression and in management of glenohumeral region disease [ 12 ]. The meticulous knowledge of the origin and course of possible SPSA variants is of paramount importance [ 9 ]. The SPSΑ course below the superior transverse scapular ligament (into the fibro-osseous tunnel) adjacent to the suprascapular nerve can reduce the amount of the surface area, exerting pressure on the nerve, causing neural microtrauma, and resulting in neuropathy [ 19 ]. Conclusions The current study reported a bilateral aberrant SPSA, originating from the AA 1st part (left side) and from the dorsal scapular artery (right side), which coexisted with adjacent neurovascular structures’ variants. The left SPSA atypically coursed below the superior transverse scapular ligament. These variants are clinically significant in imaging and surgery. Declarations Acknowledgements The authors would like to express their gratitude to body donors and their families for their highest contribution to medical education and anatomy research. Author contributions Conceptualization: MP; methodology: MP, AT, and GTs; data collection : MP, GTr, and NP; Schematic representation: NP; writing—original draft : MP, GTs, and GTr; writing—review and editing : DC, TT; critical revision of the manuscript : TT, KN; approval of the final version of the manuscript : all authors Funding None. Data availability Data will be available with the corresponding author for further reference. Conflict of interest the authors declare that they have no conflict of interest. Ethical approval as this is a single case report that is completely on a cadaver, no ethical clearance was required as the cadaver is used for teaching and research purposes. Consent for publication All the authors gave consent for the publication of the report References Alexander JG, Silva Baptista JD (2020) Coexistence of a rare case of a suprascapular artery with other vascular abnormalities: case report and potential surgical relevance. Surg Radiol Anat 42(3): 239–242. Arey LB (1963) The development of peripheral blood vessels. In: Orbison JL, Smith DE (eds) The peripheral blood vessels. Williams and Wilkins, Baltimore, pp 1–16. Cavdar S, Zeybek A, Bayramiçli M (2000) Rare variation of the axillary artery. Clin Anat 13(1): 66–68. Dargaud J, Galichon V, Dargaud Y, Quesnel T, Morin A (2002) Study of the relationship between the suprascapular artery and the brachial plexus. Surg Radiol Anat 24(20): 108–112. Dinkar S, Kamath GS, Pai VB (2015) When images lie: a variant of suprascapular artery found incidentally. BMJ case reports 2015, bcr2015211835. Feit A, Reddy CV, Cowley C, Ibrahim B, Zisbrod Z (1992) Internal mammary artery angiography should be a routine component of diagnostic coronary angiography. Cathet Cardiovasc Diagn 25(2): 85–90. Ferreira H (2015) Variations in patterns of branching of the thyrocervical trunk. Int J Pharm BioSci 6(2): 958-965 Huelke DF (1959) Variation in the origins of the branches of the axillary artery. Anat Rec 135(1): 33-41. Lamb DD (2010) Radical neck dissection. Surg Technol 449–454. Loukas M, du Plessis M, Owens DG, Kinsella CR Jr, Litchfield CR, Nacar A, Lu O, Tubbs RS (2014) The lateral thoracic artery revisited. Surg Radiol Anat 36(6): 543–549. Mahato KN (2019) Bilateral anomalous suprascapular arteries. Eur J Anat 14(1): 31–34. Mishra S, Ajmani ML (2003) Anomalous origin of suprascapular artery—a case report. J Anat Soc India 52(2): 180–182. Miller JM, Trelease RB (2014) Long head of biceps brachii perforated by a duplicated musculocutaneous nerve. Int J Anat Var 7: 62-4. Naidoo N, Lazarus L, De Gama BZ, Satyapal KS (2014) The variant course of the suprascapular artery. Fol Morphol 73(2): 206–209. Panagouli E, Natsis K, Piagkou M, Kostare G, Tsoucalas G, Venieratos D (2019) An unusual case of asymmetrical combined variations of the subclavian and axillary artery with clinical significance. Fol Morphol 78(4): 883–887. Shukla L, Gaur N, Soni G (2012) Bilateral variation in the origin of suprascapular artery. Int J Anat Var 5: 14–15. Singh R (2018) Variations in the origin and course of the suprascapular artery: case report and literature review. J Vasc Bras 17(1): 61–65. Tountas CP, Bergman RA (1993) Anatomic variations of the upper extremity. Churchill Livingstone, pp 191-196. Tubbs RS, Smyth MD, Salter G, Oakes WJ (2003) Anomalous traversement of the suprascapular artery through the suprascapular notch: a possible mechanism for undiagnosed shoulder pain? Med Sci Monit 9(3): BR116–BR119. Weiglein AH, Moriggl B, Schalk C, Künzel KH, Müller U (2005) Arteries in the posterior cervical triangle in man. Clin Anat 18(8): 553-557. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 10 May, 2023 Read the published version in Surgical and Radiologic Anatomy → Version 1 posted Editorial decision: Major revision 07 Mar, 2023 Reviews received at journal 06 Feb, 2023 Reviewers agreed at journal 16 Jan, 2023 Reviewers invited by journal 15 Jan, 2023 Editor assigned by journal 12 Jan, 2023 Submission checks completed at journal 11 Jan, 2023 First submitted to journal 09 Jan, 2023 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-2460765","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":166804809,"identity":"811f55e1-de8d-40db-bb6e-0dacb69bc701","order_by":0,"name":"Maria Piagkou","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAyUlEQVRIiWNgGAWjYJCCAwwMNkAqgTQtaSRqAYLDJGjRbT978MDPHeej+dkT2CQ+1DDYbW8goMXsTF7Cwd4zt3Nn9jxgk5xxjCF5zgFCWg7kGBzgbbudu+FGAps0DxtDsgQhh5mdf2Nw8G/budz9YC3/iNFyI8fgMG/bgdwNEkAtvG0MdkRoeZdwWLYtOXfGmYfNljP7JBKIcFju4Y9v2+xy+9uTD9748M3GnqAWBgYeGIOxAUhIJDaQoAUC7AnrGAWjYBSMgpEGAAdARBSvZUIoAAAAAElFTkSuQmCC","orcid":"","institution":"National and Kapodistrian University of Athens","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Maria","middleName":"","lastName":"Piagkou","suffix":""},{"id":166804815,"identity":"a30c06d6-185a-42b0-bd7d-24f7c95083b4","order_by":1,"name":"George Tsakotos","email":"","orcid":"","institution":"National and Kapodistrian University of Athens","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"George","middleName":"","lastName":"Tsakotos","suffix":""},{"id":166804817,"identity":"8f16994b-46e3-4698-a832-893443539e54","order_by":2,"name":"Dimitrios Chytas","email":"","orcid":"","institution":"University of Peloponnese","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Dimitrios","middleName":"","lastName":"Chytas","suffix":""},{"id":166804820,"identity":"0eab29fc-bd7b-4fc3-8c32-3affd15dc70e","order_by":3,"name":"Trifon Totlis","email":"","orcid":"","institution":"Aristotle University of Thessaloniki","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Trifon","middleName":"","lastName":"Totlis","suffix":""},{"id":166804824,"identity":"e22cee6f-52ca-48b2-9397-ced52bce0e2e","order_by":4,"name":"George Triantafyllou","email":"","orcid":"","institution":"National and Kapodistrian University of Athens","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"George","middleName":"","lastName":"Triantafyllou","suffix":""},{"id":166804825,"identity":"0de644e2-6828-477e-88f7-342355705108","order_by":5,"name":"Nikitas-Apollon Panagiotopoulos","email":"","orcid":"","institution":"National and Kapodistrian University of Athens","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Nikitas-Apollon","middleName":"","lastName":"Panagiotopoulos","suffix":""},{"id":166804831,"identity":"3e8992dd-2291-4a2b-b547-c3e5264d26ba","order_by":6,"name":"Athina Tousia","email":"","orcid":"","institution":"National and Kapodistrian University of Athens","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Athina","middleName":"","lastName":"Tousia","suffix":""},{"id":166804835,"identity":"70dd80f8-2612-4b3a-a96a-a4aaba337a9e","order_by":7,"name":"Konstantinos Natsis","email":"","orcid":"","institution":"Aristotle University of Thessaloniki","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Konstantinos","middleName":"","lastName":"Natsis","suffix":""}],"badges":[],"createdAt":"2023-01-10 00:59:15","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-2460765/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-2460765/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s00276-023-03157-0","type":"published","date":"2023-05-10T20:47:46+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":31563196,"identity":"62cab8f2-b981-498e-92e3-ebb4f0684429","added_by":"auto","created_at":"2023-01-13 22:46:00","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":3780098,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eA. \u003c/strong\u003eLeft axilla dissection and \u003cstrong\u003eB\u003c/strong\u003e. Right supraclavicular area dissection. Suprascapular vein (SPSV) passing over the superior transverse scapular ligament (STSL). Suprascapular nerve (SPSN) and suprascapular artery (SPSA) coursing below the STSL. The SPSA originated from the 1\u003csup\u003est\u003c/sup\u003e part of the axillary artery (AA). The SPSA atypical course anterior to the medial cord (MC) and posterior to the lateral cord (LC) of the brachial plexus. The musculocutaneous nerve (MCN) duplication (1, 2), AN-axillary nerve, RN-radial nerve, MN-median nerve, UN-ulnar nerve, TDN-thoracodorsal nerve, ICBN-intercostobrachial nerve, LTN-long thoracic nerve, LSBSN-lesser subscapular nerve, and PC-posterior cord, TCT-thyrocervical trunk giving rise to the ascending cervical artery (ACA), the inferior thyroid artery (ITA), and the common trunk of the main SPSA and the transverse cervical artery (TCA). TCA gave off the dorsal scapular artery (DSA). The accessory SPSA (aSPSA) emanated from the DSA, anastomosed with the SPSA (black asterisk). Both SPSAs passed over the STSL, SPSV- suprascapular vein from the transverse scapular vein (TCV) passing inferior to the STSL, CCA-common carotid artery, X-vagus nerve, PN-phrenic nerve, EJV-external jugular vein, and IJV-internal jugular vein.\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-2460765/v1/04ed03d026085a9ed38c3e78.jpg"},{"id":31563195,"identity":"eb3a94dc-f928-4bdc-ab96-ca06fce07bd5","added_by":"auto","created_at":"2023-01-13 22:46:00","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":3720748,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eA. \u003c/strong\u003eSchematic representation of the left axilla and \u003cstrong\u003eB. \u003c/strong\u003eDissection of the left axilla. 1. The aberrant suprascapular artery, 2. Superior thoracic artery, 3. 1\u003csup\u003est\u003c/sup\u003e lateral thoracic artery (LTA) from the axillary artery (AA), 4. Thoracoacromial artery, 5. 2\u003csup\u003end\u003c/sup\u003e LTA from the AA, 6. 3\u003csup\u003erd\u003c/sup\u003e LTA from the subscapular artery, 7. 4\u003csup\u003eth\u003c/sup\u003e LTA from the subscapular artery, 8. Subscapular artery, 9. 5\u003csup\u003eth\u003c/sup\u003e LTA from the subscapular artery, 10. Thoracodorsal artery, 11. Circumflex scapular artery, 12. Muscular branches to the subscapularis upper part, 13. Posterior circumflex humeral artery, 14.\u003cstrong\u003e \u003c/strong\u003eAnterior circumflex humeral artery, 15. Brachial artery, 16. Upper subscapular artery, LSBSN-lesser subscapular nerve, LTN-Long thoracic nerve, ICBN-Intercostobrachial nerve, MCN-Musculocuteaneous nerve duplication (MCN1, MCN2),\u003cstrong\u003e \u003c/strong\u003eMN-Median nerve, UN-Ulnar nerve, RN-Radial nerve, AN-axillary nerve, SBCM-subclavius muscle, PM-pectoralis major, Pm-pectoralis minor, SAM-serratus anterior muscle, yellow asterisk- the duplicated lateral root of the median nerve\u003c/p\u003e","description":"","filename":"Figure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-2460765/v1/d3705b01cb33b1f22c6ddf70.jpg"},{"id":44728457,"identity":"71502537-3422-4cd6-9cbd-ed0da2d67f53","added_by":"auto","created_at":"2023-10-16 21:03:23","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":550671,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2460765/v1/9bfff212-8e52-435c-9887-19bfea6c541c.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eA Bilateral Aberrant Suprascapular Artery Associated with Neurovascular Structures Multiplication \u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe axillary artery (AA) typical, six-branches\u0026rsquo; pattern is encountered in a quite low prevalence (27%) [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], fact that highlights the wide AA variability. The typical pattern includes the superior thoracic artery (occasionally absent), the thoracoacromial artery, the lateral thoracic artery (LTA, occasionally multiplied), the subscapular artery (occasionally fused with adjacent arteries), the anterior and posterior circumflex humeral arteries (occasionally fused) [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Supernumerary branches may also occur isolated or fused into common trunks or emanating in common with the constant vessels [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Rarely, some of the subclavian artery branches may originate from the AA (the so-called ectopic branches). Such an example is the ectopic (proximal or distal) origin of the suprascapular artery (SPSA), quite rarely [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. The SPSA typically emanates from the thyrocervical trunk, independently or by a common trunk with the transverse cervical artery (75%) [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Usually, it courses inferior to the transverse cervical artery, across the anterior scalene muscle and the phrenic nerve, behind the internal jugular vein and the sternocleidomastoid muscle. Thereafter, it continues laterally behind the subclavius muscle, crossing the subclavian artery and brachial plexus. The SPSA usually passes over the superior transverse scapular ligament and reaches the supraspinatus fossa of the scapula. The suprascapular vein that accompanies the artery usually lies ventral and superior to the SPSA [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. The SPSA may occur with a variant origin, course, and termination and coexist with other variants from the adjacent structures.\u003c/p\u003e \u003cp\u003eThe current report describes a rare bilateral aberrant origin of the SPSA from the AA 1st part (left side) and from the dorsal scapular artery (right side) identified after a careful dissection of a formalin-fixed 91-year-old male donated cadaver. The SPSAs of atypical course and termination, coexisted with adjacent neurovascular structures\u0026rsquo; variants.\u003c/p\u003e"},{"header":"Case Report","content":"\u003cp\u003eDuring dissection of a formalin-embalmed 91-year-old male donated cadaver, a bilateral aberrant SPSA was identified. The subject donated his body before death (\u003cem\u003efrom cachexia due to the Alzheimer disease\u003c/em\u003e) to the Anatomy Department of the Medical School of the National and Kapodistrian University of Athens (NKUA), through the \u0026ldquo;Anatomical Gift Program\u0026rdquo; after a written informed consent. Details of the medical record of the subject were unknown.\u003c/p\u003e \u003cp\u003e \u003cem\u003eIn the left axilla\u003c/em\u003e, at the 1st rib inferior border, the AA gave off an aberrant SPSA (atypically coursing between the brachial plexus lateral and medial cords, posterior to the lateral and medial pectoral nerves\u0026rsquo; connection) and a superior thoracic artery. The aberrant SPSA and the suprascapular nerve coursed below the superior transverse scapular ligament. The suprascapular vein ran over the superior transverse scapular ligament and emptied into the external jugular vein (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eA).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eIn the right supraclavicular area\u003c/em\u003e, a SPSA duplication was identified. The main SPSA typically emanated from the thyrocervical trunk by a common trunk with the transverse cervical artery, and coursed anterior to the brachial plexus lateral cord. At the lateral third of the clavicle, it crossed with the suprascapular nerve and passed over the superior transverse scapular ligament, accompanied by the suprascapular vein and the accessory SPSA. The accessory SPSA originated from the dorsal scapular artery, that atypically originated from the transverse cervical artery. The two SPSAs anastomosed, 1.8 cm proximal to the superior transverse scapular ligament. The suprascapular nerve arose from the brachial plexus upper trunk, ran inferior to the SPSA and passed below the superior transverse scapular ligament (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eB).\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eCoexisted variants\u003c/strong\u003e \u003cp\u003eIn the left axilla, two LTAs (the 1st and 2nd ) emanated from the AA 2nd part. The subscapular artery from the AA 3rd part, gave off the 3rd, 4th and 5th LTAs, the thoracodorsal artery, the circumflex scapular artery, muscular branches (to the lower part of the subscapularis and the teres major muscle) and the posterior circumflex humeral artery. The anterior circumflex scapular artery directly emanated from the AA. The single intercostobrachial nerve coursed through the 3rd and 4th LTAs and the long thoracic nerve descended posterior to them. A MCN and a median nerve lateral root duplication were also identified. The main MCN had a typical course and branching pattern and the accessory one innervated the coracobrachialis and the short head of the biceps brachii muscle (Figs.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eA, \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eA, \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eB). Overall, the cadaver presented no obesity or muscle atrophy. No signs of pathological conditions, trauma, or earlier surgery in the cadaver\u0026rsquo;s upper limbs were identified.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe current report describes a rare bilateral aberrant SPSA originating from the AA 1st part (left side) and from the dorsal scapular artery (right side, the accessory vessel from the duplicated SPSA). The SPSA variant origin from the subclavian artery is more common (10 and 12%) [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], compared to the rare axillary origin (incidence ranging between 1.6% and 3.8%) [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Naidoo et al. [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] reported an axillary origin of the SPSA (from the 1st part in 2% bilaterally, from the 2nd part in 5% unilaterally). Other SPSA unusual origins include the internal thoracic artery (1\u0026ndash;11%), the inferior thyroid artery (3.84%) [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], the costocervical trunk (1%) [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], the subclavian artery 1st part (1\u0026ndash;2 mm lateral to the internal thoracic artery, a high origin) [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] and the dorsal scapular artery [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Bilateral aberrant origins from the AA 3rd part (distal origins) are rare [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], as well as the SPSA distal origin from the subscapular artery, with the artery passing inferior to the superior transverse scapular ligament [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The subclavian origin of the SPSA, proximal to the internal thoracic artery, is challenging to dissect, and may cause postoperative ischemia [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Ferreira [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] described a SPSA duplication, with the accessory SPSA forming an anastomosis with the main SPSA, as in the current case. Moreover, in the current case, the SPSA atypically coursed at the left side between the brachial plexus lateral and medial cords, while at the right side its course was typical, anterior to the brachial plexus, like in the majority of the published cases (71%) [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The SPSA atypically courses between the brachial plexus upper and middle trunks in 28% and posterior to the brachial plexus in 1% [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The SPSA typically passes over the superior transverse scapular ligament [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Its course inferior to the ligament is rare (2.5%) [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. In the present case both suprascapular artery and nerve terminated inferiorly to the superior transverse scapular ligament, at the left side.\u003c/p\u003e \u003cp\u003eDevelopmentally, the main vessels derive from a primary capillary plexus. Under prevailing conditions, some vessels enlarge and reach their definite form and others regress [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. During that process, the variant branching pattern, including both the variant origin and/or course, may appear. The current report highlights the coexistence of a bilateral aberrant SPSA of atypical course and termination (unilaterally), a SPSA duplication (unilaterally), with five LTAs, a subscapular artery divided into multiple branches, a double MCN and a double lateral root of the median nerve (unilaterally). In addition, the ectopic branches coexisted with the absence of other AA branches, such as the superior thoracic artery. The accessory LTAs emanated from both the AA and the subscapular artery. In the literature, variant LTA origins include the thoracoacromial artery (67.62%), the AA (17.02%), the thoracodorsal artery (5%) and the subscapular artery (3.93%) [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. The LTAs multiplication (3.09%), as well as its variant origin are clinically important [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] since the artery should remain intact during neck and breast surgery [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. The formation of common trunks among the AA branches is quite uncommon. The subscapular artery has been identified to originate in common with the LTA (28.7%), with the posterior circumflex humeral artery (15.2%), and with the LTA and posterior circumflex humeral artery (4.7%) [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. In the present study, the accessory LTAs emerged both from the AA and the subscapular artery, similarly to Panagouli et al. [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] case, in which the LTA emerged from the subscapular artery. The abnormal origin, course and termination of the AA branching pattern may cause confusion in angiographic studies and complicate a surgery [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. In the current study, the main MCN had a typical course and branching pattern, while the accessory one innervated both coracobrachialis and the biceps brachii short head. In Miller and Trelease study [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], the duplicated MCN supplied the muscles of the anterior arm compartment and provided lateral antebrachial cutaneous innervation.\u003c/p\u003e \u003cp\u003eThe SPSA is clinically important during surgery in the anterior neck and supraclavicular region and must be identified and ligated [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. The artery\u0026rsquo;s injury may cause micro-embolic events at the suprascapular nerve small vessels leading to neuropathy [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. The knowledge of the SPSA variants is clinically important in arthroscopic suprascapular nerve decompression and in management of glenohumeral region disease [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. The meticulous knowledge of the origin and course of possible SPSA variants is of paramount importance [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. The SPSΑ course below the superior transverse scapular ligament (into the fibro-osseous tunnel) adjacent to the suprascapular nerve can reduce the amount of the surface area, exerting pressure on the nerve, causing neural microtrauma, and resulting in neuropathy [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe current study reported a bilateral aberrant SPSA, originating from the AA 1st part (left side) and from the dorsal scapular artery (right side), which coexisted with adjacent neurovascular structures\u0026rsquo; variants. The left SPSA atypically coursed below the superior transverse scapular ligament. These variants are clinically significant in imaging and surgery.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u0026nbsp;\u003c/strong\u003eThe authors would like to express their gratitude to body donors and their families for their highest contribution to medical education and anatomy research.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e \u003cstrong\u003eConceptualization:\u0026nbsp;\u003c/strong\u003eMP; \u003cstrong\u003emethodology:\u0026nbsp;\u003c/strong\u003eMP, AT, and GTs; \u003cstrong\u003edata collection\u003c/strong\u003e: MP, GTr, and NP; \u003cstrong\u003eSchematic representation:\u003c/strong\u003e NP; \u003cstrong\u003ewriting\u0026mdash;original draft\u003c/strong\u003e: MP, GTs, and GTr; \u003cstrong\u003ewriting\u0026mdash;review and editing\u003c/strong\u003e: DC, TT; \u003cstrong\u003ecritical revision of the manuscript\u003c/strong\u003e: TT, KN; \u003cstrong\u003eapproval of the final version of the manuscript\u003c/strong\u003e: all authors\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003eNone.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e Data will be available with the corresponding author for further reference.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e the authors declare that they have no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003e as this is a single case report that is completely on a cadaver, no ethical clearance was required as the cadaver is used for teaching and research purposes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e All the authors gave consent for the publication of the report\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAlexander JG, Silva Baptista JD (2020) Coexistence of a rare case of a suprascapular artery with other vascular abnormalities: case report and potential surgical relevance. Surg Radiol Anat 42(3): 239\u0026ndash;242.\u003c/li\u003e\n\u003cli\u003eArey LB (1963) The development of peripheral blood vessels. In: Orbison JL, Smith DE (eds) The peripheral blood vessels. Williams and Wilkins, Baltimore, pp 1\u0026ndash;16. \u003c/li\u003e\n\u003cli\u003eCavdar S, Zeybek A, Bayrami\u0026ccedil;li M (2000) Rare variation of the axillary artery. Clin Anat 13(1): 66\u0026ndash;68.\u003c/li\u003e\n\u003cli\u003eDargaud J, Galichon V, Dargaud Y, Quesnel T, Morin A (2002) Study of the relationship between the suprascapular artery and the brachial plexus. Surg Radiol Anat 24(20): 108\u0026ndash;112.\u003c/li\u003e\n\u003cli\u003eDinkar S, Kamath GS, Pai VB (2015) When images lie: a variant of suprascapular artery found incidentally. BMJ case reports 2015, bcr2015211835.\u003c/li\u003e\n\u003cli\u003eFeit A, Reddy CV, Cowley C, Ibrahim B, Zisbrod Z (1992) Internal mammary artery angiography should be a routine component of diagnostic coronary angiography. Cathet Cardiovasc Diagn 25(2): 85\u0026ndash;90.\u003c/li\u003e\n\u003cli\u003eFerreira H (2015) Variations in patterns of branching of the thyrocervical trunk. Int J Pharm BioSci 6(2): 958-965\u003c/li\u003e\n\u003cli\u003eHuelke DF (1959) Variation in the origins of the branches of the axillary artery. Anat Rec 135(1): 33-41.\u003c/li\u003e\n\u003cli\u003eLamb DD (2010) Radical neck dissection. Surg Technol 449\u0026ndash;454. \u003c/li\u003e\n\u003cli\u003eLoukas M, du Plessis M, Owens DG, Kinsella CR Jr, Litchfield CR, Nacar A, Lu O, Tubbs RS (2014) The lateral thoracic artery revisited. Surg Radiol Anat 36(6): 543\u0026ndash;549.\u003c/li\u003e\n\u003cli\u003eMahato KN (2019) Bilateral anomalous suprascapular arteries. Eur J Anat 14(1): 31\u0026ndash;34.\u003c/li\u003e\n\u003cli\u003eMishra S, Ajmani ML (2003) Anomalous origin of suprascapular artery\u0026mdash;a case report. J Anat Soc India 52(2): 180\u0026ndash;182.\u003c/li\u003e\n\u003cli\u003eMiller JM, Trelease RB (2014) Long head of biceps brachii perforated by a duplicated musculocutaneous nerve. Int J Anat Var 7: 62-4.\u003c/li\u003e\n\u003cli\u003eNaidoo N, Lazarus L, De Gama BZ, Satyapal KS (2014) The variant course of the suprascapular artery. Fol Morphol 73(2): 206\u0026ndash;209.\u003c/li\u003e\n\u003cli\u003ePanagouli E, Natsis K, Piagkou M, Kostare G, Tsoucalas G, Venieratos D (2019) An unusual case of asymmetrical combined variations of the subclavian and axillary artery with clinical significance. Fol Morphol 78(4): 883\u0026ndash;887.\u003c/li\u003e\n\u003cli\u003eShukla L, Gaur N, Soni G (2012) Bilateral variation in the origin of suprascapular artery. Int J Anat Var 5: 14\u0026ndash;15.\u003c/li\u003e\n\u003cli\u003eSingh R (2018) Variations in the origin and course of the suprascapular artery: case report and literature review. J Vasc Bras 17(1): 61\u0026ndash;65. \u003c/li\u003e\n\u003cli\u003eTountas CP, Bergman RA (1993) Anatomic variations of the upper extremity. Churchill Livingstone, pp 191-196.\u003c/li\u003e\n\u003cli\u003eTubbs RS, Smyth MD, Salter G, Oakes WJ (2003) Anomalous traversement of the suprascapular artery through the suprascapular notch: a possible mechanism for undiagnosed shoulder pain? Med Sci Monit 9(3): BR116\u0026ndash;BR119. \u003c/li\u003e\n\u003cli\u003eWeiglein AH, Moriggl B, Schalk C, K\u0026uuml;nzel KH, M\u0026uuml;ller U (2005) Arteries in the posterior cervical triangle in man. Clin Anat 18(8): 553-557.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"surgical-and-radiologic-anatomy","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"sara","sideBox":"Learn more about [Surgical and Radiologic Anatomy](http://link.springer.com/journal/276)","snPcode":"276","submissionUrl":"https://submission.nature.com/new-submission/276/3","title":"Surgical and Radiologic Anatomy","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"suprascapular artery, variation, origin, axillary artery, subclavian artery, lateral thoracic artery, subscapular artery","lastPublishedDoi":"10.21203/rs.3.rs-2460765/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2460765/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose \u003c/strong\u003eThe current report describes a rare bilateral suprascapular artery (SPSA) of ectopic origin. Coexisted neurovascular aberrant structures were also identified and considered from a clinical point of view.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e The variants were identified in a 91-year-old formalin-embalmed male cadaver, derived from a body donation program after a signed informed consent.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e In the left axilla, the SPSA emanated from the 1\u003csup\u003est\u003c/sup\u003e part of the axillary artery, coursed between the brachial plexus lateral and medial cords, accompanied by the suprascapular nerve, and passed below the superior transverse scapular ligament. Ipsilateral coexisted variants were the lateral thoracic artery multiplication, the subscapular artery division into multiple branches, and the musculocutaneous nerve and the median nerve lateral root duplication. In the right supraclavicular area, a SPSA duplication was identified. The main artery emanated from the thyrocervical trunk in common with the transverse cervical artery and the accessory one from the dorsal scapular artery. Both SPSAs coursed over the superior transverse scapular ligament, while the suprascapular nerve ran below the superior transverse scapular ligament.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e The SPSA atypical origin, course and location is clinically important, as the artery is usually identified and ligated during surgery. The SPSA atypical course below the superior transverse scapular ligament may be a risk factor for the suprascapular nerve compression.\u003c/p\u003e","manuscriptTitle":"A Bilateral Aberrant Suprascapular Artery Associated with Neurovascular Structures Multiplication","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-01-13 22:45:55","doi":"10.21203/rs.3.rs-2460765/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major revision","date":"2023-03-07T07:25:47+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2023-02-06T08:17:58+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"0aded080-0866-42a6-82ec-8d4680576a4b","date":"2023-01-16T18:18:37+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2023-01-15T14:54:29+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2023-01-12T16:56:28+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2023-01-11T08:58:35+00:00","index":"","fulltext":""},{"type":"submitted","content":"Surgical and Radiologic Anatomy","date":"2023-01-10T00:55:55+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"surgical-and-radiologic-anatomy","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"sara","sideBox":"Learn more about [Surgical and Radiologic Anatomy](http://link.springer.com/journal/276)","snPcode":"276","submissionUrl":"https://submission.nature.com/new-submission/276/3","title":"Surgical and Radiologic Anatomy","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"6b975037-692b-43ce-8246-756649c29287","owner":[],"postedDate":"January 13th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2023-10-16T20:54:29+00:00","versionOfRecord":{"articleIdentity":"rs-2460765","link":"https://doi.org/10.1007/s00276-023-03157-0","journal":{"identity":"surgical-and-radiologic-anatomy","isVorOnly":false,"title":"Surgical and Radiologic Anatomy"},"publishedOn":"2023-05-10 20:47:46","publishedOnDateReadable":"May 10th, 2023"},"versionCreatedAt":"2023-01-13 22:45:55","video":"","vorDoi":"10.1007/s00276-023-03157-0","vorDoiUrl":"https://doi.org/10.1007/s00276-023-03157-0","workflowStages":[]},"version":"v1","identity":"rs-2460765","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2460765","identity":"rs-2460765","version":["v1"]},"buildId":"FbvkV6FR0MCFSLy54lSbu","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}