Dr. Leonidas Miranda of North Houston Specialty Physicians, said the procedure is relatively new but very important. ARM was developed by Dr. V. Suzanne Klimberg, a breast surgeon. Miranda, a general surgeon, said he begin using the procedure about a year ago. Miranda said ARM is a major improvement because it decreased the risk of lymphedema down to 4 to 7 percent.
“In the old days we use to take the lymph nodes from the arms and breasts,” said Miranda. “This is why there was such a high rate of lymphedema, 20 to 25 percent.”
The previous procedure was a great experience but the high risk for patients developing lymphedema made it what Miranda described as a “sad situation.” It was something he said the patients should not have to endure.
“On top of the fact that they (the patients) had to go through all these treatments they had developed swollen of the arm,” said Miranda.
The new procedure, Miranda explained, helps to identify the lymph nodes coming from the arm. He said ARM involves injection of a special blue dye under the skin in the arm. The blue dye travels through the lymphatic (channels) in the arm. Miranda said the lymph nodes that are blue help the surgeons know which ones are coming from the arm.
“When you open the arm pit you see them (lymph nodes) and then you don’t take them, this is what axillary reverse mapping is,” said Miranda. “When you see those lymph nodes you only take the ones that are not blue.”
Miranda said because the surgeons do not have to remove the lymph nodes from the arm, it helps preserve the return circulation coming from the arm. This helps to prevent lymphedema.
“It does add a few more minutes to the procedure (the operating time) but it is well worth it,” said Miranda.
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