Crutch-induced aneurysms of the axillary artery

Of all upper extremity emboli, 20 per cent arise from an arterial, not cardiac, source. Therefore, one should always consider an arterial source for embolic occlusion of the axillobrachial axis. Chronic axillary crutch use in the patient with acute, noncardiac embolism of the upper extremity should suggest the diagnosis of crutch-induced axillary artery aneurysm. Treatment consists of resection of the aneurysm with reconstruction. Distal embolectomy should also be performed. Forearm fasciotomy and cervicodorsal sympathectomy should be considered in an adjunctive role. In the absence of compelling contraindications, surgical treatment should be offered at the time of discovery of the aneurysm to prevent continued microembolization to the extremity.