Axillary Artery Thrombosis After Humeral Resurfacing Arthroplasty

Shoulder arthroplasty is a very successful procedure that places significant technical demands on the sur­geon. Complications, such as neural injury and postop­erative fracture, have been reported in the literature. In this article, I describe 2 cases of axillary artery thrombo­sis that occurred after humeral resurfacing arthroplasty.

Case 1 involved a 59-year-old woman who underwent humeral resurfacing arthroplasty. In the immediate post­operative period, a vascular insult was diagnosed by decreased radial pulse and perfusion. Immediate ret­rograde angiography revealed occlusion of the axillary artery near the level of the prosthesis. Retrograde balloon thrombectomy removed an arterial thrombus and circula­tion was restored. Case 2 involved a 64-year-old woman with a latent decrease in radial pulse amplitude after humeral resurfacing. Unsuccessful balloon thrombecto­my necessitated a reverse saphenous vein bypass graft.

Axillary artery injury that occurs after anterior shoulder dislocation is well documented. Shoulder position during humeral resurfacing reproduces anterior glenohumeral dislocation and may tense the axillary artery against the edge of the pectoralis minor. Elderly patients are pre­disposed to vascular injury because of loss of arterial elasticity. Meticulous neurovascular examination is crucial throughout the postoperative period, as collateral circula­tion may conceal perfusion deficits. Prompt recognition of vascular injury may prevent circulatory compromise.