PC8. Prophylactic Axillary Lymphovenous Bypass Using the Branched Vein Graft Technique

Abstract

PURPOSE: Prophylactic lymphovenous bypass reduces the risk of lymphedema after axillary lymph node dissection (ALND). Extensive axillary dissection often creates a large gap between disrupted lymphatic vessels and potential recipient veins. The wide distribution of lymphatics throughout the lateral axilla further compounds the difficulty of including all injured vessels for bypass. We describe the technical details and preliminary clinical outcomes of patients who underwent prophylactic lymphovenous bypass using a branched vein graft (BVG) from the superficial circumflex iliac vein (SCIV). METHODS: A retrospective review was performed, focusing on operative details and clinical results. Technique: A 8-10 cm BVG containing valves is harvested from the SCIV and coupled to an appropriate recipient vein. A 27-gauge cannula is used to intubate the BVG lumen at various branch openings as appropriate. This allows a 10-0 suture to be passed outward through the cannula. Lymphatic vessels are then captured and intussuscepted into the BVG with 4 - 6 mm of overlap, without any bunching or kinking. Upon completing the bypass, the intussuscepting suture is removed to avoid lymphatic obstruction. Valves in the graft prevent reflux. RESULTS: Seven patients were identified for inclusion. A median of 3 disrupted lymphatic vessels were encountered per case (range 1-5). Follow-up was 3 weeks to 6 months. Six patients demonstrated no clinical evidence of lymphedema. 1 patient had trace swelling localized to the thumb at 2 months. CONCLUSION: The branched vein graft technique effectively facilitates the immediate bypass of multiple injured lymphatics over a wide area after ALND.