Original ArticlesOcclusion of the brachial artery by thrombus dislodged from a traumatic aneurysm of the anterior humeral circumflex artery☆
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 Quadrilateral Space Syndrome in 3 Overhead Throwing Athletes: An Underdiagnosed Cause of Digital Ischemia
2017, Annals of Vascular SurgeryVascular injuries in the upper extremity in athletes
2015, Hand ClinicsCitation Excerpt :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
Aneurysmal degeneration of the humeral artery
2012, AngiologiaSonographic evaluation of the axillary artery during simulated overhead throwing arm positions
2008, Physical Therapy in SportCitation Excerpt :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.
Diagnosis and management of arterial compression at the thoracic outlet
1997, Annals of Vascular SurgeryIschemia of the Throwing Hand in Major League Baseball Pitchers: Embolic Occlusion from Aneurysms of Axillary Artery Branches
1995, Journal of Vascular and Interventional Radiology
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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.