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      Ultrasound assessment of the posterior circumflex humeral artery in elite volleyball players: Aneurysm prevalence, anatomy, branching pattern and vessel characteristics

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          Abstract

          Objectives

          To determine the prevalence of posterior circumflex humeral artery (PCHA) aneurysms and vessel characteristics of the PCHA and deep brachial artery (DBA) in elite volleyball players.

          Methods

          Two-hundred and eighty players underwent standardized ultrasound assessment of the dominant arm by a vascular technologist. Assessment included determination of PCHA aneurysms (defined as segmental vessel dilatation ≥150 %), PCHA and DBA anatomy, branching pattern, vessel course and diameter.

          Results

          The PCHA and DBA were identified in 100 % and 93 % (260/280) of cases, respectively. The prevalence of PCHA aneurysms was 4.6 % (13/280). All aneurysms were detected in proximal PCHA originating from the axillary artery (AA). The PCHA originated from the AA in 81 % of cases (228/280), and showed a curved course dorsally towards the humeral head in 93 % (211/228). The DBA originated from the AA in 73 % of cases (190/260), and showed a straight course parallel to the AA in 93 % (177/190).

          Conclusions

          PCHA aneurysm prevalence in elite volleyball players is high and associated with a specific branching type: a PCHA that originates from the axillary artery. Radiologists should have a high index of suspicion for this vascular overuse injury. For the first time vessel characteristics and reference values are described to facilitate ultrasound assessment.

          Key Points

          • Prevalence of PCHA aneurysms is 4.6 % among elite volleyball players.

          • All aneurysms are in proximal PCHA that originates directly from AA.

          • Vessel characteristics and reference values are described to facilitate US assessment.

          • Mean PCHA and DBA diameters can be used as reference values.

          • Radiologists need a high index of suspicion for this vascular overuse injury.

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          Most cited references38

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          Positional compression of the axillary artery causing upper extremity thrombosis and embolism in the elite overhead throwing athlete.

          G A Paletta, David Wright, Yazan Duwayri … (2011)
          To describe the spectrum of axillary artery pathology seen in high-performance overhead athletes and the outcomes of current treatment. A retrospective review of patients that had undergone management of axillary artery lesions in a specialized center for thoracic outlet syndrome (TOS). Treatment outcomes were assessed with respect to arterial pathology and operative management. Nine male athletes were referred for arterial insufficiency in the dominant arm between January 2000 and August 2010, representing 1.6% of 572 patients treated for TOS (19% of 47 patients treated for arterial TOS). 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 numbness (four), cold hypersensitivity/Raynaud's (two), rest pain (one), and cutaneous fingertip embolism (one). Three patients 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 patients had occlusion of the distal axillary artery opposite the humeral head either at rest (three) or with arm elevation (three), one had axillary artery dissection with positional occlusion, and two had thrombosis of circumflex humeral artery aneurysms. Five patients had embolic arterial occlusions 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 aneurysms (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 patients had continued careers in professional baseball, although one retired during long-term follow-up. Repetitive positional compression of the axillary artery can cause a spectrum of pathology in the overhead athlete, including focal intimal hyperplasia, aneurysm formation, segmental dissection, and branch vessel aneurysms. Prompt recognition of these rare lesions is crucial given their propensity toward thrombosis and distal embolism, 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 branch aneurysms, as well as concomitant management of distal thromboembolism. Copyright © 2011 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.
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            Vascular complications in high-performance athletes.

            C Zarins, Frank Arko, Michael Olcott … (2001)
            The purpose of this study was to evaluate our experience with the diagnosis and management of vascular injuries in a group of high-performance athletes. Between June 1994 and June 2000, we treated 26 patients who sustained vascular complications as a result of athletic competition. Clinical presentation, type of athletic competition, location of injury, type of therapy, and degree of rehabilitation were analyzed retrospectively. The mean age of the patients was 23.8 years (range, 17-40). Twenty-one (81%) patients were men, and five (19%) were women. Athletes included 8 major-league baseball players, 7 football players, 2 world-class cyclists, 2 rock climbers, 2 wind surfers, 1 swimmer, 1 kayaker, 1 weight lifter, 1 marksman, and 1 volleyball player. There were 14 (54%) arterial and 12 (46%) venous complications. Arterial injuries included 7 (50%) axillary/subclavian artery or branch artery aneurysms with secondary embolization, 6 (43%) popliteal artery injuries, and 1 (7%) case of intimal hyperplasia and stenosis involving the external iliac artery. Subclavian vein thrombosis (SVT) accounted for all venous complications. Five of the seven patients with axillary/subclavian branch artery aneurysms required lytic therapy for distal emboli, and six required operative intervention. All popliteal artery injuries were treated by femoropopliteal bypass graft with autogenous saphenous vein. The external iliac artery lesion, which occurred in a cyclist, was repaired with limited resection and vein patch angioplasty. All 12 patients with SVT were treated initially with lytic therapy and anticoagulation. Eight patients required thoracic outlet decompression and venolysis of the subclavian vein. Thirteen arterial reconstructions have remained patent at an average follow-up of 31.9 months (range, 2-74). One patient with a popliteal artery injury required reoperation at 2 months for occlusion of his bypass graft. Eleven of the patients with an arterial injury were able to return to their prior level of competition. All of the patients with SVT have remained stable without further venous thrombosis and have returned to their usual level of activity. Athletes are susceptible to a variety of vascular injuries that may not be easily recognized. A high level of suspicion, a thorough workup including noninvasive studies and arteriography/venography, and prompt treatment are important for a successful outcome.
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              Peripheral artery aneurysm.

              Heather Hall, Samantha Minc, Trissa Babrowski (2013)
              Peripheral aneurysms typically present as asymptomatic incidental findings or may present with symptoms when there is local compression of other structures, such as nerves or veins, with ischemia, or rarely with rupture. Larger and symptomatic aneurysms should be repaired. Ultrasonography, computed tomography angiography, and magnetic resonance angiography can be used to define inflow and outflow and better characterize the aneurysm, particularly size and thrombus. Repair of peripheral aneurysms typically involves resection with interposition grafting, although certain anatomic sites may be amenable to endovascular approaches. Femoral pseudoaneurysms can be managed with observation, surgical repair, ultrasound-guided compression, or ultrasound-guided thrombin injection.
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                Author and article information

                Contributors
                Daan van de Pol: +31-20-5661666 , +31-20-5669119 , daanvandepol@gmail.com
                Journal
                Journal ID (nlm-ta): Eur Radiol
                Journal ID (iso-abbrev): Eur Radiol
                Title: European Radiology
                Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )
                ISSN (Print): 0938-7994
                ISSN (Electronic): 1432-1084
                Publication date (Electronic): 2 June 2016
                Publication date PMC-release: 2 June 2016
                Publication date (Print): 2017
                Volume: 27
                Issue: 3
                Pages: 889-898
                Affiliations
                [1 ]ISNI 0000000404654431, GRID grid.5650.6, Department of Radiology, , Academic Medical Center/University of Amsterdam, ; PO Box 22700, NL-1100 DE Amsterdam, The Netherlands
                [2 ]ISNI 0000000404654431, GRID grid.5650.6, Coronel Institute of Occupational Health, , Academic Medical Center/University of Amsterdam, ; Amsterdam, The Netherlands
                Article
                Publisher ID: 4401
                DOI: 10.1007/s00330-016-4401-8
                PMC ID: 5306316
                PubMed ID: 27255398
                SO-VID: 868fce5b-0ab5-4c6d-a790-0ea6928927fd
                Copyright © © The Author(s) 2016
                License:

                Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                History
                Date received : 2 November 2015
                Date revision received : 30 April 2016
                Date accepted : 3 May 2016
                Funding
                Funded by: Academic Medical Center (AMC)
                Categories
                Subject: Ultrasound
                Custom metadata
                issue-copyright-statement © European Society of Radiology 2017

                ScienceOpen disciplines: Radiology & Imaging
                Keywords: ultrasound,posterior circumflex humeral artery,volleyball,aneurysm,surveillance
                Data availability:
                ScienceOpen disciplines: Radiology & Imaging
                Keywords: ultrasound, posterior circumflex humeral artery, volleyball, aneurysm, surveillance

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