Surgical techniques: Axillary artery reconstruction for ATOS

Extrinsic compression of the distal axillary artery or its immediate branches can cause unique vascular lesions that represent a variant of arterial TOS. These lesions are occasionally reported in overhead athletes, such as baseball pitchers and volleyball players, for whom positional compression of the artery opposite the head of the humerus has led to aneurysm formation, with thrombosis and/or embolism to the arteries of the arm or hand. The unique clinical setting of these lesions requires different considerations from those applicable to other forms of TOS or vascular disease. This chapter describes the spectrum of pathology and the outcomes of treatment for compressive axillary artery lesions, with particular emphasis on the methods of surgical treatment and the subsequent return to highperformance overhead athletic activity.