Symposium At Oxford Lymphoedema Practice On LVA

I was delighted to receive an invite to attend this event in the Manor Hospital in Oxford. It was attended by lymphoedema specialists and therapists mostly from the closer surrounding counties, but some had travelled quite a distance to hear specialists speak on this exciting subject. These events are always a good opportunity to meet up with old work colleagues and to put faces to names of those who you regularly hear about, or have communicated with, but haven’t met face-to-face. Most therapists and those working with lymphoedema patients have heard of LVA. However, unfortunately at present, this ‘treatment’ isn’t available through the NHS in England. It is however, available to patients in Wales. Despite this, their inclusion and exclusion criteria is extremely tight and, out of 8000 patients with lymphoedema, only 46 patients per year are able to have the procedure. Super-microsurgery for lymphoedema has been around for a while, but in recent years it is being used more in prevention and, for those with long standing issues. Microsurgery is a surgery that is performed beyond the limits of human sight, so microscopes are required. When you’re joining vessels of between 0.2mm and 0.8mm in diameter, using sutures that are thinner than a human hair, it is then classed as ‘super’ microsurgery. Prior to surgery, and to establish if patients are suitable for surgery, a special diagnostic test is done. This is called ICG lymphography or ‘fluoroscopy’. This is when a dye is injected between the first and second digits and the movement of the dye through the lymphatic vessels is viewed via infrared camera. This test allows surgeons to see if there are functioning lymphatics, where they are and therefore if surgery is viable. This is also an invaluable tool for mapping the lymphatics so that patients and their therapists can see where blockages are, and where the lymph fluid is draining to. According to the Oxford Lymphoedema Practice, 80% of patients with longstanding, or chronic lymphoedema, have shown an improvement in their condition. And they have also found that having this surgery vastly reduces the incidence on recurrent infection – cellulitis – a common complaint in those with lymphoedema. Since this symposium, I have referred two of my BCRL (breast cancer related lymphoedema) patients who, having had regular manual lymphatic drainage, robust compression garments, and intensive decongestive therapy, are not responding as well as I had hoped. So, I have recommended they have the fluoroscopy to see what’s going on with their lymphatics. I will update you on how it goes in a future blog, after their appointment.