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Arterial anastomosis around elbow

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arterial anastomosis around elbow joint diagram

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Arterial Anastomosis Around the Elbow (Cubital Anastomosis)

The arterial network encircling the elbow joint is called the cubital anastomosis (rete cubiti). It is formed by the meeting of descending branches from above (from the brachial artery and its deep branch) with ascending recurrent branches from below (from the radial, ulnar, and common interosseous arteries).
Cubital anastomosis - THIEME Atlas labeled diagram
Labeled diagram showing all named vessels of the cubital anastomosis (THIEME Atlas of Anatomy)

Descending (Collateral) Branches - from Above

These arise from the brachial artery and its largest branch, the deep artery of the arm (profunda brachii):
ArterySourceSide
Radial collateral arteryDeep artery of the armLateral
Middle (medial) collateral arteryDeep artery of the armPosterior/lateral
Superior ulnar collateral arteryBrachial artery (higher up)Medial; runs with ulnar nerve
Inferior ulnar collateral arteryBrachial artery (just above medial epicondyle)Medial

Ascending (Recurrent) Branches - from Below

These arise from the forearm arteries after the brachial artery bifurcates in the cubital fossa:
ArterySourceAnastomoses with
Radial recurrent arteryRadial artery (first branch)Radial collateral artery
Anterior ulnar recurrent arteryUlnar arteryInferior ulnar collateral artery
Posterior ulnar recurrent arteryUlnar arterySuperior ulnar collateral artery
Interosseous recurrent arteryPosterior interosseous artery (from common interosseous)Middle collateral artery

Three Vascular Arcades (Surgical Classification)

From Rockwood & Green's Fractures in Adults (10th ed., 2025), the blood supply to the adult elbow is organized into three consistent vascular arcades:
  • Lateral arcade: Interosseous recurrent + radial recurrent + radial collateral arteries - supplies the capitellum, radial head, and lateral epicondyle
  • Medial arcade: Superior and inferior ulnar collaterals + anterior and posterior ulnar recurrent arteries - supplies the medial epicondyle and medial trochlea
  • Posterior arcade: Middle collateral artery + contributions from medial and lateral arcades - supplies the olecranon fossa and supracondylar area
Brachial artery and cubital anastomosis - full arm view
Course of axillary and brachial arteries with branches and cubital anastomosis (Color Atlas of Human Anatomy)

Clinical Significance

  1. Ligation of the brachial artery: Because this anastomotic network is so rich, the brachial artery can be ligated distal to the origin of the deep artery of the arm (profunda brachii) without compromising blood supply to the forearm - the collateral circulation through the cubital plexus compensates. Ligation proximal to the profunda origin is dangerous.
  2. Radial artery harvest for grafting: When the radial artery is removed as a surgical graft (e.g., for coronary artery bypass), adequate collateral circulation is maintained via the ulnar artery and its recurrent vessels through the cubital anastomosis.
  3. Supracondylar fractures in children: Injury to the brachial artery just above the elbow in supracondylar humerus fractures is clinically significant - if the deep artery of the arm origin is also compromised, the anastomotic network may be insufficient, leading to Volkmann's ischaemic contracture.
  4. Supracondylar process / Struthers' ligament: The rare supracondylar process (~0.7% of population) can form a fibro-osseous canal that entraps the brachial artery and median nerve.
Sources:
  • Color Atlas of Human Anatomy, Vol. 2 (Thieme), pp. 106-107 - Brachial Artery & Cubital Anastomosis
  • THIEME Atlas of General Anatomy and Musculoskeletal System - Arterial anastomoses around the elbow joint
  • Fischer's Mastery of Surgery, 8th ed. - Brachial Artery
  • Rockwood & Green's Fractures in Adults, 10th ed. (2025) - Pathology and Applied Anatomy, Distal Humerus
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