Stapleton C H, Green D J, Cable N T, George K P
Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, UK.
Ultrasound Med Biol. 2009 Sep;35(9):1443-51. doi: 10.1016/j.ultrasmedbio.2009.03.017. Epub 2009 Jul 17.
The presence of axillary artery aneurysm and/or thrombus in overhead throwing athletes has been linked, theoretically, with the finding of compression by the humeral head induced by a diagnostic arm maneuver. However, whether this intermittent compression is incidental or of pathological significance has yet to be determined. Flow-mediated vasodilation (FMD), intima-media thickness (IMT) and maximum vasodilatory capacity were measured locally (3rd portion of the axillary artery) and downstream (brachial artery) in individuals previously tested for inducible axillary artery compression (compressor group [COMP]: n=8, mean (SD) age: 23 (4) y; "noncompressor" control group [NONCOMP]: n=8, 26 (4) y). A high-resolution ultrasound machine recorded arterial diameter and blood flow velocity. A rapid inflation/deflation pneumatic cuff placed distal to the site of measurement induced reactive hyperemia. Custom-designed wall tracking software with synchronized Doppler waveform analysis detected changes in arterial diameter, blood flow velocity and shear rate from baseline to 3min after cuff deflation. Glyceryl trinitrate and/or ischemic hand grip exercises were administered to induce maximum vasodilation. No significant differences in FMD, IMT or maximum vasodilator capacity were observed between groups at the axillary artery. However, the downstream brachial FMD response was significantly diminished in the COMP group (6.38 [3.28]%) compared with the NONCOMP group (10.38 [2.74]%; p=0.006) despite a comparable shear rate between groups (COMP: 81.92 (44.55) s(-1); NONCOMP: 83.18 (40.02) s(-1); p=0.961). Pooled data revealed a significant negative relationship (r=-0.52, p=0.038) between the FMD response and degree of arterial compression. These results suggest a chronic change in downstream vascular function in individuals demonstrating clinically significant inducible axillary artery compression.
理论上，过头投掷运动员腋窝动脉动脉瘤和/或血栓的存在与诊断性手臂动作引起的肱骨头压迫有关。然而，这种间歇性压迫是偶然的还是具有病理意义尚未确定。对先前接受过诱导性腋窝动脉压迫测试的个体，在局部（腋窝动脉第三部分）和下游（肱动脉）测量血流介导的血管舒张（FMD）、内膜中层厚度（IMT）和最大血管舒张能力（压缩机组[COMP]：n = 8，平均（标准差）年龄：23（4）岁；“非压缩机”对照组[NONCOMP]：n = 8，26（4）岁）。一台高分辨率超声机器记录动脉直径和血流速度。在测量部位远端放置一个快速充气/放气的气动袖带以诱导反应性充血。定制设计的壁跟踪软件与同步多普勒波形分析检测从基线到袖带放气后3分钟动脉直径、血流速度和剪切率的变化。给予硝酸甘油和/或缺血性手握练习以诱导最大血管舒张。两组在腋窝动脉处的FMD、IMT或最大血管舒张能力无显著差异。然而，尽管两组之间的剪切率相当（COMP：81.92（44.55）s⁻¹；NONCOMP：83.18（40.02）s⁻¹；p = 0.961），但COMP组下游肱动脉的FMD反应与NONCOMP组相比显著降低（6.38[3.28]%对10.38[2.74]%；p = 0.006）。汇总数据显示FMD反应与动脉压迫程度之间存在显著负相关（r = -0.52，p = 0.038）。这些结果表明，在表现出临床上显著的诱导性腋窝动脉压迫的个体中，下游血管功能发生了慢性变化。
