Lymphatico-Venouse Anastomosis + Primary Lymphoedema

[Mush]

The article in the current edition of Lymphline appears to infer that LVA is only effective in the treatment of secondary lymphoedema. Is there any evidence of its success in primary lymphoedema?

[Rebec]

I haven't read anything about the subject you are interested in, but, from what I understand about the procedure, it seems that it might work when the lymphoedema is in its earlier stages, so from this I deduce that primary lymphoedema might be discovered at a too late a stage to benefit from this type of surgery. I might be wrong but it might be useful to read, in the first place, what is the main difference between the two types of lymphoedema and then maybe the answer could be found in it.

[LVASurgeon]

Dear Mush,

I have performed this procedure with success in both primary and secondary lymphoedema cases.

The key to success in primary lymphoedema is to properly select the patient. This means that the patient should undergo ICG lymphography in the clinic to determine whether they have adequate lymphatic channels for the procedure to be technically possible.

A recent study from Turkey showed that the procedure was possible in 67/80 patients with primary lymphoedema of the leg, compared to 20/21 patients with secondary lymphoedema. See ncbi.nlm.nih.gov/pubmed/200...

As always with LVA, the earlier the procedure is done, the better. Indeed, if we catch it early enough, it is possible to make the lymphoedema so much better that compression garments are not required.

However, even patients with advanced lymphoedema - as long as they still have some functioning lymphatic channels on ICG lymphography - still benefit greatly from LVA. It is particularly good at getting rid of cellulitis episodes, and reduces feelings of tightness and heaviness in the limb, increases flexibility, and eventually reduces the size of the limb in around 85% of patients with advanced lymphoedema who have the procedure.

I hope this answers your question, and if you need more info, please get in touch.

[Mush in reply to LVASurgeon]

Thank you very much for this extremely helpful response. I am already booked in to see my GP to discuss taking steps to have the ICG as a first step

[Christina38 in reply to LVASurgeon]

Have any children with lymphoedema benefitted from the LVA procedure?