Repetitive Traumatic Injury in an Elite Volleyball Player Leading to Brachial Artery Thrombosis
John Kubasiak, MD, Neha Sheng, MD, Erin Farlow, MD, Richard Keen, MD.
Cook County Hospital, Chicago, IL, USA.
OBJECTIVES: Repetitive subclinical vascular injuries occur more frequently in elite athletes than previously suspected. Recent studies of elite volleyball players place symptoms of self-reported symptoms of digital ischemia at 11-27%. On ultrasound assessment the prevalence of aneurysm approaches 5% in the same population. We aim to present a case of upper extremity ischemia caused by brachial artery thrombosis secondary to lateral circumflex artery aneurysm and to review the literature of this disease process. METHODS: A 24-year-old male volleyball player presented, on referral, with acute ischemia of the upper extremity shortly after a match. On exam he had absent radial and ulnar pulses and dysesthesia. On angiogram was found to have occlusion of the brachial, radial and ulnar artery. On attempted thrombolysis a thrombosed aneurysm of the lateral circumflex artery was encountered and therapy was unsuccessful. (Image 1) RESULTS: He was then taken to the operating room and the imaging findings were confirmed. The aneurysm was identified and local thrombectomy performed, on exploration of the bifurcation of the brachial artery the vessels appeared to have evidence of chronic thrombus. With these findings we elected to proceed with axillary to brachial artery bypass with reversed saphenous vein. He tolerated the procedure well, and was recently seen in clinic for four-year follow up and maintains his volleyball routine.
CONCLUSIONS: Traumatic aneurysm of the circumflex humeral artery is more prevalent than previously thought in elite athletes. The true prevalence is unknown and ultrasound imaging should be considered in patients with symptoms. Our patient represents a treatment option in those with acute on chronic thrombotic disease, which after treatment has maintained 4-year potency, and also allowed the patient to return to normal activity.
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