Positional compression of the axillary artery causing upper extremity XXXX and @entity887 in the elite overhead throwing athlete.

@entity1 @entity455 @entity1183 @entity1373 @entity9085 @entity887 @entity439 @entity56 @entity1031 @entity158 @entity432 @entity715 @entity531 @entity4066
OBJECTIVES: To describe the spectrum of axillary artery pathology seen in high-performance overhead athletes and the outcomes of current treatment. METHODS: A retrospective review of @entity1 that had undergone management of @entity455 in a specialized center for @entity531 ( @entity531 ). Treatment outcomes were assessed with respect to arterial pathology and operative management. RESULTS: Nine male athletes were referred for @entity9085 in the dominant arm between January 2000 and August 2010, representing 1.6% of 572 @entity1 treated for @entity531 (19% of 47 @entity1 treated for arterial @entity531 ). Seven were elite baseball pitchers (six professional, one collegiate), and two were professional baseball coaches with practice pitching responsibilities, with a mean age of 30.9    2.9 years. Presenting symptoms included arm fatigue (five), finger @entity1183 (four), cold @entity56 /Raynaud's (two), @entity158 (one), and cutaneous fingertip @entity887 (one). Three @entity1 underwent transcatheter thrombolysis prior to referral, including one with angioplasty and stenting. At angiography and surgical exploration 2.5    0.8 weeks after symptom presentation (range, 1-8 weeks), six @entity1 had occlusion of the distal axillary artery opposite the humeral head either at rest (three) or with arm elevation (three), one had axillary @entity4066 with positional occlusion, and two had @entity715 of circumflex humeral artery @entity439 . Five @entity1 had embolic @entity432 distal to the elbow. Treatment included segmental axillary artery repair with saphenous vein (n = 7; five interposition bypass grafts and two patch angioplasties), ligation/excision of circumflex humeral artery @entity439 (n = 2), and distal artery thrombectomy/thrombolysis (n = 2). Mean postoperative hospital stay was 3.8    0.5 days, and the time until resumption of unrestricted overhead throwing was 10.8    2.7 weeks. At a median follow-up of 15 months (range, 3-123 months), primary-assisted patency was 89%, and secondary patency was 100%. All nine @entity1 had continued careers in professional baseball, although one retired during long-term follow-up. CONCLUSIONS: Repetitive positional compression of the axillary artery can cause a spectrum of pathology in the overhead athlete, including focal intimal @entity1373 , @entity439 formation, segmental dissection, and branch vessel @entity439 . Prompt recognition of these rare lesions is crucial given their propensity toward @entity715 and @entity887 , with positional arteriography necessary for diagnosis. Full functional recovery can usually be anticipated within several months of surgical treatment, consisting of mobilization and segmental reconstruction of the diseased axillary artery or ligation/excision of @entity439 , as well as concomitant management of distal @entity1031 .
