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This is a report of axillary vein leiomyosarcoma managed with surgical resection and adjuvant radiation therapy. A 61-year-old male with history of renal cell carcinoma and pharyngeal squamous cell carcinoma was found to have a left axillary mass on a follow-up Positron Emission Tomography–Computed Tomography (PET-CT). A biopsy demonstrated leiomyoma. The patient subsequently developed progressive neurological symptoms in the left upper extremity for which he underwent Magnetic Resonance Imaging (MRI) followed by surgical exploration. This showed a 3 cm globular mass originating from the axillary vein with no involvement of the adjacent nerves. The mass was resected en bloc with mobilization and primary reconstruction of the axillary vein. Final pathology analysis demonstrated high-grade venous leiomyosarcoma with clear margins.

Hemodialysis Reliable Outflow (HeRO) grafts (Merit Medical Systems, Inc, South Jordan, Utah) provide a means for access in catheter-dependent hemodialysis patients but typically require several weeks for tissue incorporation. Modifying the HeRO graft with an ACUSEAL graft (W. L. Gore & Associates, Newark, Del) can allow immediate cannulation, thus reducing catheter dependence time and its associated complications. A retrospective review of patients at our institution from 2013 to 2016 who underwent placement of a modified HeRO dialysis system with ACUSEAL graft was performed. Complications and outcomes were analyzed, with patency rates and hours to successful cannulation being major end points. Modified HeRO grafts were successfully placed in 10 catheter-dependent patients. Postoperative complications included two thromboses and one hematoma. At 6 months of follow-up, mean time to graft cannulation was 33.7 hours, with 100% success; the primary and secondary patency rates were 70% and 90%, respectively. Our modification allows an accelerated use of the HeRO system, reducing catheter dependence time with acceptable postoperative complications and patency rates.