LVA post-surgery treatment

[annsmile]

Dear lymphies, those who have had LVA surgery, what did your post-surgery treatment include? How many anastomoses were performed and what was the stage of your LE? How soon after the surgery did you see the improvement? Sorry for so many questions) Looking forward for your replies! Thanx!

[lymphite]

I had these same questions before I did it. I had LVA 8 weeks ago. Recovery was 4 weeks of bandaging 23 hours a day. No massage, compression aerobic exercise or lifting more than 10 lbs for 4 weeks. After that return to same care as before surgery. I saw immediate improvement but hard to assess because the wrapping left my arm very wrinkled. The improvement when I finally was done with wrapping was noticeable and has slowly continued to improve.

I had mild lymphedema but stable with daily self massage/ some therapist massage and compression during the day. Arm was 8% larger pre and is 3% larger now based on the machine that measures arm volume.

It's hard to describe the improvement. The shape of my arm has returned and muscles and veins are visible again. It is smaller of course but more important is the skin is soft and thinner with fine wrinkles. I find it gets a little bigger in the heat or with heavier muscle use but easily returns to this new size and texture so there is a big emotional benifit that comes with a feeling of it being under control. I just don't think about it as much or feel anxious about whether it is getting bigger all the time.

I still wear compression sleeve most of the time but not all the time as I used to. Bare at night as before. PI tried going without for an hour or 2 before surgery and my arm would ache and my tape measurements would show 2-3/16ths inch increase in that amount of time. Now I have several times left off the sleeve with no change. I still do manual massage but not as long or even everyday.

[annsmile in reply to lymphite]

Dear lymphite, thank you so much for the detailed answer!

[lymphite in reply to annsmile]

I keep checking to see any other replies from other people who have had LVA. I guess there just aren't that many of us. I follow Oxford Lymphedema Practice on twitter and I recently saw them report that since they started which I believe was in 2012 they have done 136 surgeries. I had 5 total incisions all in the forearm. I don;t know if they did more than one anastomosis per incision. I had only had lymphedema for about 7 months.

[MsDEL]

Hi, sorry to only just see this question. I had LVA at Oxford four years ago. My five anastomoses were in one leg and all but one in my lower leg. Treatment post op was just to be without pressure stocking for two weeks while my wounds healed, then to return to using them. I didn't return to using my compression machine for a good while as I didn't need it post op. My leg reduced dramatically over the first few weeks and stayed much smaller than it was previously- I can't remember figures for sure now but there was something like an 80% reduction.

Every now and again my leg will swell a bit, but it's usually when I've been on my feet too much. My compression machine and elevation usually sees it shifted. LVA has simply made my Lymphodema so much easier to manage!

I hope you are as pleased with yours!

Denise

[lymphite in reply to MsDEL]

I am so happy for you. Great result!

[annsmile in reply to MsDEL]

So happy for you!

[Blueshift in reply to MsDEL]

Hi Denise . So encouraged to hear this . I want to have LVA treatment ASAP

[christinej1950]

Sorry, only just seen this. I had the surgery at Oxford just over 2 years ago. I developed LD post cancer surgery in left arm after about 18 months. I'd only had it for about 6 months, but I was devastated. It was 15% bigger. I had 4 incisions creating 11 anamastoses. I wore compression sleeve daytime only almost immediately after LVA for about a month, then only when doing gardening, long drives, housework etc. At my final appointment in April my measurement was stable at 5%. After the first year I pretty much stopped wearing the sleeve and rarely did any massage. The difference in my arms is barely noticeable, I'm no longer at risk of cellulitis and it no longer aches or swells, although it does quite often tingle. These days I never wear a sleeve. I'm so grateful to OLP. Btw I'm 67 now and can do all things I used to without fear of consequences. Good luck

[lymphite in reply to christinej1950]

Thank you so much for your post! It has helped me to have the confidence to start weaning off the sleeve even more than the small amount I have been. It is especially helpful to know that stability is possible even though there is still some enlargement. I was starting to realize that if I had a little increase in swelling it was easily managed and returned to the previous low point.

[Microsurgeon]

Hi Annsmile

I am one of the surgeons in Oxford who performs LVA. There have been some great replies above but I will give my perspective.

The No 1 aim after surgery is to get the wounds healed. This is to reduce the risk of lymphorrea (fluid leak from the wound) and wound infection. Normally the skin sutures are left in for 14 days and then removed. We ask patients not to wear garments for 3-5 days post op as we are worried that pulling a tight garment up the limb might put strain on the skin sutures and slow healing. Then we encourage the use of compression garments to squeeze more lymph across the LVA and reduce the volume of the limb. In Oxford we continue with the patient's pre op compression and don't change anything. This allows us to see if the LVAs have worked without the confounding factors of changing compression etc. The patients can undergo light activites e.g. driving, walking, with the limb post op until the scars are healed and sutures removed. A couple of weeks off gardening / heavy gym work is sensible. After suture removal and skin healing all activities can be resumed.

The time taken to see effect is variable. Some of our patients have reported a reduction the next day, some it takes 6 months. This depends on a wide range of factors. Also bear in mind that this operation is good for getting rid of excess fluid but will not deal with the fat hypertrophy associated with long term lymphoedema.

With regards to number of anastomosis (joins from lymphatic to vein) there is evidence in the literature (and common sense) that the more anastomosis are performed the quicker the final result and better it should be (up to a certain point). However the quality of the anastomosis is also important, the amount of fluid that lymphatic is pumping and the size of the lymphatic are also important. In Oxford we do as many joins as possible routinely and have two surgeons operating at the same time using two microscopes to try and achieve this.

Finally the timing of the operation is important. Generally lymphoedema is a chronic and progressive disorder, but progress is unpredictable. Some people develop severe swelling in months whilst others take many years. This is thought to be due to a progressive fibrosis of the lymphatic vessels in the limb (paper by Mihara et al). For LVA to work well, those lymphatic channels that are operated on need to be pumping lymphatic fluid along them and so across the anastomosis. If the lymphatics are scarred and not working so well then the results will not be as good. These questions and assessments take place pre operatively using ICG scanning. We aim to give the patient an idea as to wether they are a good candidate for this operation or not. Ideally we get patients relatively early in the process so that the residual lymphatic in the limb have good function. For some patients 'early' might be a few months, others might be years.

As an additional note to this, in an attempt to treat patients early we can screen high risk patients (post cancer treatment) to make the diagnosis of lymphoedema as early as possible i.e. BEFORE they develop any swelling. This then give patients the knowledge of the problem early and they can then decided what it is the best treatment option for them.

Hope that is not too long winded and makes some sense.

AJR

[lymphite in reply to Microsurgeon]

Thank you so much for this clear and informative post. I had my LVA in Chicago and was only told that becoming free of compression was not the goal but that some people do stop wearing compression sleeves. That left me trying to figure out how to find out if I was one of those people on my own. Your explanation of the factors involved will help.

[annsmile in reply to Microsurgeon]

Microsurgeon, your reply is very informative. Thank you!

[wfaw in reply to Microsurgeon]

wonderful . Thank you so much for this post microsurgeon.

my lva failed, only had it on my lower arm but now my upper arm has got bigger [post cancer lymph]. i am now not sure what to do, but you have helped me on the way to make a decision, thank you for taking the time to explain things.

[CCT67]

As this is a UK site the responses don't capture experiences of Americans having LVA in the US. There are many who have had LVA and have posted about it and could respond to your questions within Facebook LE support groups (closed groups you can ask to join). Two very good groups for feedback on SAPL, LVA, and VLNT are

1. Lymphie Strong Inspiration Group

2. Lymphedema -support, awareness and ...

There are several LE groups on FB however some are open to the public with posts being fully public while others are closed groups with better confidentiality.

If you do have LVA good luck!

[annsmile in reply to CCT67]

Thank you!

[Ali_Marzouqi]

Hi

My name is Ali Al Marzooqi , I am 42 from UAE.

I had LVA surgery for my left leg , performed in South Korea , I had 7 anastomoses . I saw inmdiately improvement after surgery and 5 cm reduction in circumference. I received banadaging directly after surgery and professor advised me for daily BAndaging 24 hours for 2 years . Also advised me for very limited walking and 2 months full rest. I stay for days in hospital and I seen doctor twice after surgery before I leave to country . I asked to follow up after 6 months . Bandaging material is different than what I was using before surgery , its type like steaky ones and easy to perform .