Lymphaticovenous Anastomosis

Lymphaticovenous Anastomosis

Lymphaticovenous anastomosis (LVA) surgery is part of the Granzow System^SM of lymphedema treatment.  LVA surgery is the least invasive when compared to other lymphedema surgeries with the fastest recovery. Published studies by Dr. Granzow and others have shown that LVA surgery has significantly decreased or eliminated the need for compression garments and therapy in his lymphedema patients.

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.

An Improved Surgical Technique

Dr. Granzow and Dr. Isao Koshima performing lymphaticovenous anastomosis in Japan in 2005

Lymphaticovenous anastomosis (LVA) surgery uses superfine microsurgery, or “supermicrosurgery”, to connect lymphatic channels in the affected limb to nearby veins.  These connections create additional outflow pathways to drain excess lymph fluid.  Lymphatic vessels are tiny, typically ranging from 0.1 mm to 0.9 mm in diameter, and the superfine sutures used are only slightly larger than the thickness of a single strand of hair.  LVA surgery uses specialized techniques, superfine instruments and the highest power operating room microscopes. The level of surgical skill required to identify the lymphatics, carefully separate them from the often severely scarred surrounding tissues and properly connect them to appropriate veins is among the highest in any surgical field.

As with VLNT surgery, LVA surgery works best for patients with stage 0 or stage 1 lymphedema, where fluid accumulation causes swelling.  Dr. Granzow and his team carefully assess each patient to determine the best treatments for each individual case.

 2-Stage Technique for Patients with Stage 2 Lymphedema

When properly used as part of a complete lymphedema surgery system, such as the Granzow System^SM, LVA can effectively reduce the need for compression garments and lymphedema therapy even in patients with stage 2 lymphedema.  In these patients with advanced lymphedema disease, Granzow SAPL^SM surgery is used first to remove the excess pathologic lymphedema solids.  After healing is complete, LVA and VLNT surgeries can be used to further decrease symptoms and lymphatic fluid accumulation.  Dr. Granzow pioneered this use of VLNT and LVA surgery after Granzow SAPL^SM surgery to successfully and consistently treat these patients.

Contact us to learn more about the Lymphaticovenous anastomosis (LVA) surgery. 

Lymphaticovenous anastomosis (LVA) FAQs

What is lymphaticovenous anastomosis surgery?
Lymphaticovenous anastomosis (LVA) surgery is part of the Granzow System ^SM of lymphedema treatment. LVA is a superfine microsurgery, or supermicrosurgery, that connects lymphatic channels in the affected limb to nearby veins.

In this minimally invasive surgery, a surgeon will take a series of lymphatics in the affected areas such as the hand, wrist, leg or foot and connect them directly to veins. This allows the blocked lymphatic fluid to again drain back into the venous system. By finding the right lymphatic channels, disconnecting them, and connecting them to tiny, appropriately sized veins with one-way valves, the flow of lymphatic fluid returns to the body’s natural circulation and drains as it should.

LVA surgery is the least invasive option compared to other lymphedema surgeries, which means it also allows for the fastest recovery.

Who is eligible for lymphaticovenous anastomosis?
Lymphaticovenous anastomosis is best suited for patients with Stage 0 or Stage 1 lymphedema. Swelling in Stage 0 and Stage 1 lymphedema is caused by an accumulation of excess lymphatic fluid. LVA helps the body drain that excess fluid and keep it moving.

Once lymphedema progresses to Stage 2, solids also start to accumulate in the affected limb. These solids need to be removed using another method like SAPL^SM surgery. Once the patient has healed from the SAPL surgery, LVA can be used to further decrease symptoms and lymphatic fluid accumulation.

Though surgery will significantly reduce the size of the affected arm or leg, most patients will need to continue to wear compression garments for at least a portion of their day. These garments augment the remaining deficiencies in a patient’s lymphatic drainage. Their use is decreased as healing improves. Patients may need to continue working with a physical therapist in the months following their procedure.

Dr. Granzow and his team carefully assess each patient to determine which treatment is best for each individual patient. He can determine if LVA will be an effective option for you and can put together a plan to get you the results you desire.

How successful is LVA surgery?
Studies have shown that LVA surgery can significantly reduce the size of the affected limb and the pain associated with lymphedema.

What are the risks of lymphaticovenous anastomosis?
There are generally very few risks associated with lymphaticovenous anastomosis. Much like any low-risk surgery, LVA carries the small risk of post-operative infection. However, when used as part of the Granzow System, LVA dramatically decreases the risk of dangerous cellulitis infections as is described in our lymphedema publications.

Any surgery that uses anesthesia, specifically general anesthesia, carries very minor risks, most notably, post-operative nausea. If you need or elect to have general anesthesia, those very small risks will exist.

Local vs. general anesthesia
Because lymphaticovenous anastomosis is a minimally invasive surgery, patients can typically get by with local anesthesia. Depending on the patient’s medical history and risk factors, a doctor may opt to use general anesthesia, but those cases are not common.

Dr. Granzow has safely performed thousands of surgeries using both general anesthesia and local anesthesia. His training and experience give him maximum flexibility in determining the most appropriate course of treatment for each patient.

General anesthesia

• Used for surgeries conducted in a hospital setting
• Used for SAPL surgery, where larger volumes of fat need to be removed
• Pain-free surgery
• Slight increase in surgical risk (<1%)

Local anesthesia

• Used for surgeries conducted in a clinical setting
• Used to remove smaller amounts of fat
• Pain during surgery varies by surgeon and patient (we recommend consulting Yelp or patient reviews)
• Less risk in very heavy patients

What is the recovery time for lymphaticovenous anastomosis?
Because the surgical sites for lymphaticovenous anastomosis are so small, patients will be up and walking the day after their surgery. Pain should be minimal and the surgery recovery should be relatively easy and quick.

Do I need therapy after LVA?
Though surgery is an important component of lymphedema treatment, therapy must be included in a patient’s treatment plan both before and after surgery. Not only does therapy provide long-term relief, but it is almost always the first step in treating lymphedema. In fact, many surgeons, including those at Granzow Lymphedema and Lipedema Center, won’t see a patient until they’ve been working with a trained lymphedema therapist. There are many reasons for this.

First, conservative therapies alone may relieve lymphedema symptoms and eliminate the need for surgery. A patient’s therapist will also have a good understanding of where the biggest problem areas are, which is a big help in the operating room. Finally, therapy will be necessary post-surgery, and a patient needs to have an existing relationship with a therapist to increase the long-term success of LVA.

Can lymphedema swelling return after the LVA surgery?
Lymphatic fluid can technically reaccumulate after surgery, causing swelling in the patient’s affected limb. That’s why the Granzow System includes a plan for long-term care, including lymphedema therapy and compression garment use to prevent fluid from reaccumulating and to stop the progression of the disease

Through therapy and the continuous use of custom-fit, flat knit compression garments are needed for all Stage 1 (and Stage 2) lymphedema patients after surgery, both should be significantly reduced thanks to LVA.

How to find an LVA surgeon
Lymphedema is a very specific disorder that hasn’t historically received much attention in the medical community. The lack of awareness around lymphedema has often led to misdiagnoses, leaving patients living in pain and confusion for years. When they seek help from a cosmetic plastic surgeon who knows little about lymphedema, the result is a botched surgery and more pain.

If you have severe swelling in one arm or leg that is painful, ask your general practitioner about a lymphedema specialist. Board-certified surgeons and therapists who are specifically trained to perform lymphedema treatments, including LVA, can provide the relief you deserve and are the only practitioners who will help you achieve long-term relief.

Dr. Jay Granzow is an internationally renowned board-certified plastic surgeon who specializes in lipedema and lymphedema treatment like LVA. Patients come from all over the country to seek treatment at the Granzow Lymphedema & Lipedema Center, which has a reputation for delivering real results.

Why do I need a board-certified plastic surgeon?
Lymphaticovenous anastomosis surgery is a very specific supermicrosurgery that varies greatly from standard plastic surgery. Lymphatic vessels are tiny, typically ranging from 0.1 mm to 0.9 mm in diameter, and the superfine sutures used are only slightly larger than the thickness of a single strand of hair. LVA surgery uses specialized techniques, superfine instruments, and the highest power operating room microscopes. The level of surgical skill required to identify the lymphatics, carefully separate them from the often severely scarred surrounding tissues and properly connect them to appropriate veins is among the highest in any surgical field.

For these reasons, it’s essential to work with a doctor who is board-certified by the American Society of Plastic Surgeons (ASPS). Board certification in plastic surgery is difficult to attain and involves completing a full-time plastic surgery residency and successfully passing a rigorous exam. Unqualified surgeons could potentially cause more damage to a patient, elongating their path to recovery.

Does insurance cover LVA surgery?
LVA can and should be covered by insurance, but coverage is often difficult to obtain. Because lymphedema is a little-known disease, many insurance providers will deny requests for coverage for lymphedema treatment. However, by working with our patient advocate team, patients can secure insurance coverage in most cases.

To learn more about LVA for lymphedema or schedule a consultation, contact the team at the Granzow Lymphedema & Lipedema Center.