2025 Clinician Corner - Ligation with patch angioplasty of the axillary artery for circumflex humeral artery aneurysms

Abstract 

Circumflex humeral artery aneurysms are rare vascular injuries that can lead to disastrous consequences if there is a delay or error in diagnosis. Previously only described in young elite athletes, this case series of eight patients, including a symptomatic 59-year-old man, illustrates the need for its inclusion in the differential in isolated arm ischemia regardless of age. Ligation without revascularization is the most commonly reported intervention; however, this does not address the axillary artery inflammatory thickening associated with the development of these aneurysms. We propose that aneurysm ligation with patch angioplasty of the axillary artery enables treatment of all arteries affected in the quadrilateral space.    

Keywords:  CHAA

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Faculty credentials/disclosure 

The planners and faculty for this activity have no relevant financial relationships to disclose. The patient consented to the publication of this report.

Process

Click the "add to cart/begin" button, pay any relevant fee, take the quiz, complete the evaluation, and claim your CME credit.  You must achieve 100% on the quiz with unlimited attempts available.

  • By completing this process, you are attesting that you have read the journal article.

Expiration date:

Credit eligibility for this article is set to expire on November 1, 2026.

Learning Objectives

After completing the article, the learner should be able to:

  • Describe the pathophysiology of circumflex humeral artery aneurysms and identify at-risk patients presenting with acute limb ischemia.  
  • Describe the appropriate surgical and postoperative management of acute limb ischemia from embolic/thrombotic events caused by circumflex humeral artery aneurysms. 
  • Perform the appropriate diagnostic workup for patients in whom circumflex humeral artery aneurysm is suspected.  

Key Points 

  • Circumflex humeral artery aneurysms (CHAA) develop due to repetitive overhead motion, resulting in inflammation of the axillary artery and aneurysmal dilation of the posterior and/or anterior circumflex branches.   
  • We recommend single antiplatelet or anticoagulation agent postoperatively, as the nidus for formation of emboli has been addressed and continued therapy increases bleeding complications without clear benefit. The choice of medication and duration of therapy should be directed by the severity and extent of limb ischemia, distribution of thromboemboli, small versus large vessel occlusion, and status of the limb post thromboembolectomy, if performed. Prolonged anticoagulant therapy is generally unnecessary and may mandate activity restrictions or predispose to bleeding complications in this physically active, athletic group of patients. 
  • Simple ligation of the CHAA is not satisfactory, and our recommended surgical repair is endoaneurysmorrhaphy through an axillary arteriotomy and axillary artery repair with patch angioplasty. 
  • Our case highlights the need for a high level of suspicion in physically active patients presenting with upper-extremity embolic events and an otherwise unclear source.  

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Course summary
Available credit: 
  • 1.00 American Board of Internal Medicine (ABIM) MOC Part 2
    Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.00 MOC points in the American Board of Medicine’s (ABIM) Maintenance of Certification (MOC) program. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.
  • 1.00 American Board of Surgery (ABS) Accredited CME
    Successful completion of this CME activity enables the learner to earn credit toward the CME requirement of the American Board of Surgery’s Continuous Certification program. It is the CME activity provider's responsibility to submit learner completion information to ACCME for the purpose of granting ABS credit.
  • 1.00 AMA PRA Category 1 Credit™
    The A. Webb Roberts Center for Continuing Medical Education of Baylor Scott & White Health is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
  • 1.00 Attendance
Course opens: 
11/01/2025
Course expires: 
11/01/2026
Cost:
$25.00
Rating: 
0
  • Kristina Weitzel, MD - Baylor University Medical Center, Dallas, Texas, USA 
  • Gregory Pearl, MD - Baylor Scott & White The Heart Hospital, Dallas, Texas, USA 
  • Rebecca Parker, MD, MPH - Baylor University Medical Center, Dallas, Texas, USA 
  • Kyle Grimsley - Baylor University Medical Center, Dallas, Texas, USA 
  • Bradley Grimsley, MD - Baylor Scott & White The Heart Hospital, Dallas, Texas, USA

Accreditation

The A. Webb Roberts Center for Continuing Medical Education of Baylor Scott & White Health is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Designation

AMA PRA Category 1 Credit™

The A. Webb Roberts Center for Continuing Medical Education of Baylor Scott & White Health designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

ABS CC

Successful completion of this CME activity enables the learner to earn credit toward the CME requirement of the American Board of Surgery’s Continuous Certification program. It is the CME activity provider's responsibility to submit learner completion information to ACCME for the purpose of granting ABS credit.

ABIM MOC

 Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.0 MOC points in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

 

Available Credit

  • 1.00 American Board of Internal Medicine (ABIM) MOC Part 2
    Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.00 MOC points in the American Board of Medicine’s (ABIM) Maintenance of Certification (MOC) program. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.
  • 1.00 American Board of Surgery (ABS) Accredited CME
    Successful completion of this CME activity enables the learner to earn credit toward the CME requirement of the American Board of Surgery’s Continuous Certification program. It is the CME activity provider's responsibility to submit learner completion information to ACCME for the purpose of granting ABS credit.
  • 1.00 AMA PRA Category 1 Credit™
    The A. Webb Roberts Center for Continuing Medical Education of Baylor Scott & White Health is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
  • 1.00 Attendance

Price

Cost:
$25.00
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