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Diagnosis And Management Of Axillary Branch Aneurysms In High Performances Athletes
John H. Cabot, MD, Jason T. Lee, MD.
Stanford Healthcare, Stanford, CA, USA.
Introduction: Axillary branch aneurysms, though rare, are a potential cause of upper extremity ischemia seen in high performance athletes. These lesions most commonly develop at the posterior humeral circumflex artery in individuals that engage in repetitive overhead motions
(Figure 1). Given the rarity of this condition, treatment is often delayed due to misdiagnosis. Here we present to our knowledge, the largest single institution experience to date in treating this condition.
Methods: Single-center retrospective review was conducted of all individuals who underwent evaluation and treatment for axillary branch aneurysm between 2010-2025. Return to previous level of competition was the primary outcome measurement.
Results: Seven athletes were treated during the study period, the majority of which were baseball pitchers. Except for one collegiate pitcher and one semi-professional tennis player, all patients were professional athletes. Presenting symptoms are detailed in
Table 1. The median time from the onset of symptoms to presentation was 194 days. Direct angiography was performed for all patients to facilitate diagnosis and operative planning. Three patients received catheter directed thrombolysis during their angiogram. All patients underwent ligation of the aneurysmal vessel through a muscle-sparing transaxillary approach. Following treatment, one patient experienced a minor hematoma - no other complications were reported. All patients returned to play at their previous level within three months of treatment.
Conclusion: Axillary branch aneurysms are rare lesions that are predominately seen in high performance athletes. We demonstrate that ligation through a muscle-sparing transaxillary approach is a safe an effective treatment enabling prompt return to competition.
Figure1: Angiographic and intraoperative demonstration of posterior humeral circumflex artery aneurysm
Table 1: Patient characteristics and postoperative outcomes | |
| Median Age at Presentation (Range) | 27 (19-57) |
| Sport | |
| Baseball Pitcher | 4 (57.14%) |
| Football Quarterback | 2 (28.57%) |
| Tennis | 1 (14.29%) |
| Level of Competition | |
| Professional | 5(71.43%) |
| Collegiate | 1(14.29%) |
| Semi-Professional | 1(14.29%) |
| Median Days from Onset of Symptoms to Presentation (Range) | 194 (14 -1506) |
| Presenting Symptoms | |
| Pokilothermia, Discoloration | 7 (100%) |
| Paresthesia | 6 (85.71%) |
| Weakness | 5 (71.43%) |
| Pain | 3 (42.86%) |
| Wound | 2 (28.57%) |
| Distribution of Thrombus During Initial Angiogram | |
| Axillary Artery | 1 (14.29%) |
| Brachial Artery | 1 (14.29%) |
| Ulnar Artery | 4 (57.14%) |
| Radial Artery | 2 (28.57%) |
| Postoperative Complication | |
| Hematoma | 1 (14.29%) |
| Mean Days from Surgery to Return of Play (Range) | 62.85(28-90) |
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