Coil embolization of a posterior circumflex humeral aneurysm in a volleyball player

Abstract

Key message: Vascular injuries to the posterior circumfl ex humeral artery are a rare clinical entity but may result in digital ischemia due to embolic dislodgement following repetitive and exaggerated overhead motions in active sportspeople. showed satisfactory position of the coils (Fig. 3). Anticoagulation was discontinued after 3 months. Follow-up MRI demonstrated successful occlusion of the right PCHA (Fig. 4). At six months follow-up she was asymptomatic with no complaints and returned to playing volleyball. DiscussionVascular injuries to the posterior circumfl ex humeral artery (PCHA) are a rare but signifi cant problem in highperformance athletes who engage in overhead throwing activities. It has been reported in baseball pitchers [1] and several studies amongst elite volleyball players have documented aneurysm formation of the PCHA [2 -6]. A recent survey revealed that a high percentage of volleyball players in the Netherlands, with a mean age of 24, self-reported symptoms of digital ischemia. The prevalence of cold digits during practice and competition was 27 %. The study was prompted by increased numbers of volleyball players presenting with ischemic digits of the dominant hand associated with vascular injuries to the PCHA and resulting distal emboli [2]. Other literature has demonstrated that a volleyball career longer than 17 years is associated with a 6.7-fold increase in the risk of ischemia-related complaints in the dominant hand [7]. In volleyball, the overhead spiking and serving motion involves excessive external rotation and hyper-abduction of the shoulder [8]. During this manoeuvre, the relatively fi xed circumfl ex arteries are potentially subjected to compression by the humeral head. Cadaver dissections have shown that as the arm is moved into an overhead position, the axillary artery becomes compressed by the humeral head, which acts like a fulcrum [9]. Furthermore, sonographic investigations revealed that the glenohumeral joint is anteriorly translated during the overhead motion and that there is a correlation between such displacement and the degree of axillary artery compression and more distal fl ow-mediated vasodilation [10,11]. Positional compression of the distal axillary artery and its branches may cause chronic irritation leading to aneurysmal degeneration [12]. Turbulent fl ow in these aneurysms readily produces mural thrombus which is susceptible to distal embolisation during hyperextension as the humeral head acts to compress the aneurysm, thus pushing the thrombus into the distal arterial stream [12 -14]. The thromboembolic complications of the aff ected extremity will result in manifestations of digital ischemia, as seen in our patient. Embolic occlusions of the distal arteries in the hand may result in disabling pain, numbness, coldness, discoloration and occasional ulcerations. Clinical presentations of thromboembolic complications, however, can be subtle and often remain undetected for a long time due to the rich collateral network around the shoulder [2]. Importantly, ...

Posterior circumflex humeral artery pathological lesions with digital ischemia in an elite volleyball player: A case report and literature review

“…We found 19 cases of volleyball-related PCHA pathological lesions in English literature ( Table 1 ). 1 , 4 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 All had symptoms in the dominant hand, although not listed in the table. The mean age was 24.1 years old (17–35), and six patients were females.…”