Lymphaticovenous anastomosis (LVA) describes a method of directly connecting the lymphatic vessels in the affected area of the body to the tiny veins nearby. This allows the excess lymphatic fluid to drain directly into the vein and be returned to the body’s natural circulation.
It can usually be performed as a daycase procedure with the patient returning home the day of the surgery.
LVA surgery is an effective solution in patients with very early stages of lymphedema, without any fibrosis and sclerosis of the remaining lymphatic vessels, and lifetime garments are prescribed.
What does the surgery involve?
Small incisions are made on the limb at regular intervals to allow several dilated lymphatic vessels to be rerouted into a nearby vein. This provides an alternative pathway for the lymphatic flow. It can be carried out either under general anaesthetic (you are fully asleep) or local anaesthetic with sedation (you are awake but drowsy). Many patients will go home the same day.
What are the risks and side effects of surgery?
Having lymphoedema surgery can be a very positive experience. Complications are infrequent and usually minor. However, no surgery is without risk and it is important that you have a clear understanding of associated risks with this procedure.
Scar – are very small and hidden in a skin crease. They should be barely perceptible. However some people heal with thick scars and this can make them more noticeable.
Bruising and swelling – is very common and may take a couple of weeks to settle.
Infection – is not common but may require a course of antibiotics. You will be given a course of antibiotics to cover you during the healing process.
No improvement – is possible that an LVA may not improve your lymphoedema or that it may not be long-lived.
Worsening of lymphoedema – is possible due to disruption of existing lymphatics .
DVT/PE/fat embolus – following any surgical procedure it is possible to develop a blood clot in your legs, which could potentially break off and move to your lungs. If the blood clot is large enough it could prove fatal. In order to reduce any risks of this we give you special stockings to wear in bed and a blood thinning injection if you are not mobile.
All the risks will be discussed in detail at your consultation. However, if you have further questions or concerns, do not hesitate to discuss these with me. Decisions about plastic surgery should never be rushed and you should do as much personal research as possible.
What happens after the operation?
At the end of the procedure, your usual compression garment will be applied to the area to help reduce any lymphoedema and pressure on the new connections. Our lymphoedema nurse will ensure you have the correct amount of compression.
As long as you are feeling well after the operation, you will be able to go home the same day or the following day. You will not be able to drive yourself home from hospital and ideally, you should have someone to stay with you for a few days to assist you.
Before you leave the hospital, a follow up appointment will be booked with the nurse for 1 week and an appointment with me for 4-6 weeks or sooner should you have any problems.
What is the estimated time for recovery, absence from work and return to usual activities?
I hope you find this information useful. If you have any questions or require a little more information then please do not hesitate to contact me.