Original Articles
Occlusion of the brachial artery by thrombus dislodged from a traumatic aneurysm of the anterior humeral circumflex artery

https://doi.org/10.1067/mva.1991.25235Get rights and content

Abstract

The successful treatment of a brachial artery occlusion caused by a chronic embolizing aneurysm of the anterior humeral circumflex artery is described. In the case of embolizing axillary artery aneurysms, the best therapy is resection of the aneurysm followed by distal thromboembolectomy and vascular reconstruction by a saphenous vein segment. Prosthetic material should be reserved as a second choice. In this particular case successful therapy consisted of ligation of the anterior humeral circumflex artery proximal and distal to the aneurysm, resection of the aneurysm, and transcubital thromboembolectomy. (J VASC SURG 1991;13:408-11.)

Section snippets

Case report

A 22-year-old athletic black man had a history of coolness, paleness, and pain in this right hand and forearm for 1 year before our operation. This occurred after stress, especially after his favorite sport: fistball. After observing the first symptoms (4 weeks), he went to his family doctor and he consulted a neurologist. After this he was sent to a general surgeon who advised him to consult our vascular surgery outpatient department.

The patient had a 7-year history of cigarette smoking.

Operative technique

The axillary artery was explored by an axillary incision along the medial margin of the biceps muscle and the coracobrachial muscle in the axilla. A fusiform aneurysm of the anterior humeral circumflex artery was found dorsal to the tendon of the coracobrachial muscle next to the humerus. The tendon of this muscle was cautiously separated from the aneurysm, which had a length of 4.5 cm and a diameter of 3.5 cm. The aneurysm was resected after ligation of the anterior humeral circumflex artery,

Histopathologic study

This showed an aneurysm of the muscular type with already older organized thrombosis and adventitial fibrosis with hemosiderine deposits. Instead of the more typical changes of atherosclerosis there was severe fraying and fragmentation of the tunica elastica.

Discussion

Acute occlusion of the brachial artery is caused by an embolization or by a thrombotic occlusion after a trauma.

Most cases of acute embolization in the brachial artery are cardiac in origin. They are a result of atrial fibrillation, myocardial infarction, ventricular aneurysm, or valvular heart disease. The remaining embolizations are originated from lesions in or proximal to the brachial artery, either from aneurysms, post-stenotic dilations, or atherosclerotic dilations. Traumatic occlusion

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Cited by (18)

  • Vascular injuries in the upper extremity in athletes

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    Angiographic confirmation of the quadrilateral space syndrome may be shown with occlusion of the posterior humeral circumflex artery with the arm in abduction and external rotation. Chronic compression and repeated trauma over the artery can occur in overhand motion athletes such as baseball pitchers and volleyball players and may result in artery occlusion or aneurysm formation causing subsequent embolization (Fig. 1).9 In addition, inflammation of any or all of the muscular borders of the quadrilateral space may constrict the space around the PCHA and axillary nerve and cause gradual onset of symptoms.8

  • Sonographic evaluation of the axillary artery during simulated overhead throwing arm positions

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    Clinically, it is postulated that this manoeuvre stresses the vasculature to accurately reproduce the signs (e.g., radial pulse disappearance) and symptoms (e.g., ischaemic pain, paraesthesia, anaesthesia, heaviness) of vascular compromise. Published case studies have used advanced imaging techniques (i.e., arteriograms, angiograms, ultrasound) to confirm suspected vascular compromise of the axillary artery and its branches, with patency of the arteries in a neutral upper limb position compared to a stenosed or occluded vessel in the hyperabducted position (Arko et al., 2001; Cormier, Matalon, & Wolin, 1988; Fields et al., 1986; Ishitobi et al., 2001; Kee et al., 1995; Nijhuis & Muller-Wiefel, 1991; Redler, Ruland, & McCue, 1986; Reekers, den Hartog, Kuyper, Kromhout, & Peeters, 1993; Rohrer et al., 1990; Schneider, Kasparyan, Altchek, Fantini, & Weiland, 1999; Todd et al., 1998; Vlychou et al., 2001). Imaging results influence the management of the condition which, in many cases, results in surgery.

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Reprint requests: H. H. A. M. Nijhuis, MD, St. Johannes-Hospital, An der Abtei 7-11, 4100 Duisburg 11, Federal Republic of Germany.

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