title: Axillary vein abnormalities contribute to development of lymphoedema after surgery for breast cancer.
abstract: BACKGROUND
  The aetiology of breast cancer-related lymphoedema (BCRL) is poorly understood and multifactorial. Previous work has suggested that acquired abnormalities of the axillary vein may contribute to arm swelling. This prospective study evaluated venous changes in patients with a new diagnosis of breast cancer who had surgery that included axillary lymph node clearance.
  
  
  METHODS
  Patients underwent arm volume measurement and Doppler ultrasonographic assessment of the axillary vein before, and at 3 and 12 months after surgery.
  
  
  RESULTS
  A complete data set was available for 70 patients. BCRL was observed in 16 per cent at 3 months and 11 per cent at 12 months. Significant alterations to venous flow patterns were observed in those with BCRL. Vein wall movement was significantly reduced after surgery for the group as a whole, but did not correlate with arm swelling. Venous stenosis with impaired flow was also observed in the absence of BCRL.
  
  
  CONCLUSIONS
  Axillary clearance can cause altered flow within the axillary vein, which is associated with an increased risk of developing lymphoedema.
authors.affiliation: Cambridge Breast Unit, Addenbrooke's Hospital, Hills Road, Cambridge CB2 2QQ, UK.
authors.forename: S J
authors.initials: SJ
authors.lastname: Pain
authors.forename: S
authors.initials: S
authors.lastname: Vowler
authors.forename: A D
authors.initials: AD
authors.lastname: Purushotham
mesh_terms: D001132:Arm / Q000098:blood supply; D001365:Axilla; D001367:Axillary Vein / Q000503:physiopathology*; D001783:Blood Flow Velocity / Q000502:physiology; D001943:Breast Neoplasms / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods; D008209:Lymphedema / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D011300:Preoperative Care / Q000379:methods; D011446:Prospective Studies; D012307:Risk Factors; D018616:Ultrasonography, Doppler, Duplex