Interventional procedure overview of lymphovenous anastomosis during axillary or inguinal node dissection for preventing secondary lymphoedema

What the procedure involves

This version of LVA is known as LYMPHA (lymphatic microsurgical preventative healing approach). It is done during axillary or inguinal node dissection to reduce the risk of LE developing after surgery. It involves creating a bypass from the transected lymphatics to nearby veins. Before the node dissection, a blue dye is injected to map the lymphatic circulation from the arm or thigh. During the node dissection, the surgical team inserts the cut lymphatic vessels into a small branch of the axillary or saphenous veins with the aim of restoring normal lymph flow.

The standard LYMPHA technique is done by surgeons with microvascular experience, using an operating microscope and, typically, 9‑0 to 12‑0 sutures. There is also a simplified technique known as S‑LYMPHA, which can be done by surgeons without microsurgical training, without an operating microscope and using 7‑0 sutures.