Vascular Alterations in Axillary and Brachial Vessels in Patients with Axillary Web Syndrome After Breast Cancer Surgery

Cintia Furlan, Carolina Nascimben Matheus, Rodrigo Menezes Jales, Sophie Derchain, and Lu´ıs Ota´vio Sarian, Lymphatic Research and Biology 2017

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Vascular Alterations in Axillary and Brachial Vessels in Patients with Axillary Web Syndrome After Breast Cancer Surgery

Cintia Furlan, Carolina Nascimben Matheus,  Rodrigo Menezes Jales, Sophie Derchain, and Lu´ıs Ota´vio Sarian, Lymphatic Research and Biology 2017

Background: Surgical manipulations of the axilla may cause a condition known as Axillary Web Syndrome (AWS). The systems compromised and the sequence of events leading to this syndrome remains unknown. This study evaluated clinical, surgical, and vascular factors associated with onset and duration of AWS after breast cancer surgery.

Methods and Results: In this prospective study, 155 women were included. They were submitted to a physical examination that consisted of ultrasound Doppler of axillary and brachial vessels and the evaluation of AWS in 1, 3, and 6 months after breast cancer surgery. Women with advanced disease had a significantly higher incidence of AWS than those with early stage breast cancer (p=0.02). In addition, women who underwent mastectomy or axillary lymph node dissection (ALND) had a significantly higher incidence of AWS in the 1month (p<0.01; p<0.01) and 3-months (p<0.01; p=0.02) assessment rounds, respectively. The cross sectional area of brachial artery was significantly smaller (p=0.04) in women with AWS at the 3-months postoperative visit. The peak systolic velocity and the blood flow of the axillary artery was significantly higher in women with AWS 6 months after surgery (p<0.03 and p=0.02 respectively).

Conclusion: Our study confirm the combined changes of lymphatic and vascular systems in woman with AWS, since AWS was associated with more extensive dissection of axillary lymph nodes, compromised lymph nodes, and with abnormalities of the vascular parameters.

Main findings

  • There were detected diameter restrictions of the brachial artery (6 months after surgery) and an increase in velocity and blood flow in the axillary artery (12 months postoperative) in women with AWS.
  • Regardless of the etiology, or of the elements that composes the AWS cord, they detected arterial changes, which can influence the circulation of the affected upper limb.
  • The higher velocity and flow in the axillary artery of women with AWS may be associated with higher fluid in the extravascular space and thus higher lymphatic pressure.
  • AWS involves vascular and lymphatic combined disorders
  • The higher prevalence of AWS in the mastectomy group can be the consequence of a more aggressive approach to axilla.
  • This study detected a significantly higher prevalence of AWS in the third month after surgery in patients with advanced disease (stage III) compared to women with early stage breast cancer.
  • Age and BMI were not associated with the prevalence of AWS.