Fellow ASDIN members,

In the last 20 some years of my IN career, I have come across few patients with AV accesses created intentionally or unintentionally ipsilateral to axillary LN dissection (+/- XRT, often associated in this case with axillary vein stenosis). The outcome was (unanimously) the development of arm swelling, namely significant lymphedema, leading (with only 1 exception in my experience) to the ligation of the access. Some entertain the option of a "low flow system". I have not seen that work... 

Logically speaking, an ipsilateral HeRO graft, should not lead to the same outcome (from the severity standpoint), since it is bypassing the outflow veins/drainage system of the ipsilateral UE. I assume, there is still a concern of developing central vein stenosis from the outflow component of the HeRO graft, but I don't see that being a major deterring factor. 

I came across a situation like that today, the patient has an occluded right innominate vein and widely patent left sided central veins (left UE venogram was not performed) where an extensive axillary LND was performed. A left IJV TDC was placed and I am exploring the option of a HeRo on that side.

Has anyone done that? What was the outcome?

Thx

Tony Samaha, MD

Cincinnati, Ohio