[Atypical compression of the humeral axial artery treated by surgical arteriolysis]

A 28-year-old man with atypical humeral artery compression presented clinical signs and results of Doppler tests suggestive of a cervicothoracic outlet syndrome: dysesthesie disorders and pain in left upper limb on active abduction. Murmurs over the vascular pathways were not elicited on clinical examination. Pulses were palpable in the upper limbs at rest but were abolished during abduction and external rotation. Data were confirmed by velocimetric studies, and dynamic arteriography showed absence of compression at the cervicothoracic outlet but its presence at the humeral head level. Axillohumeral surgical exploration provided evidence of compression of the nerve-vessel bundle, which was stretched within its sheath over the head of humerus. Incision of the fibrous sheath and freeing of the artery restored distal vascular pulsatility during abduction movements. This clinical pseudosyndrome of the cervicothoracic outlet appears to result from a rare cause of compression situated distal to this anatomic zone, and to respond to simple treatment.