Lymphaticovenous Anastomosis
Lymphaticovenous anastomosis describes a method of directly connecting the lymphatic vessels in the affected area of the body to the tiny veins nearby. This allows the backed-up lymphatic fluid to drain directly into the vein and be returned to the body's natural circulation.
The procedure has been an effective and long-term solution for the lymphedema in many patients. In our experience, most patients have results which range from a moderate improvement almost a complete resolution of their condition.
A goal of the procedure is to eliminate the need for further use of compression garments. Most of our patients have achieved this goal.
An Improved Surgical Technique
Dr. Granzow had adapted his surgical method for this procedure from Dr. Isao Koshima, one of the fathers of microsurgery. Dr. Koshima pioneered the techniques of supermicrosurgery and has applied his methods to improving the outcomes of lymphaticovenous anastomosis surgery. Dr. Granzow studied with Dr. Koshima in Japan and maintains close professional contact with him. Current results show much greater success rates than were reported previously by other surgeons who attempted to perform the the lymphatocovenous anastomosis technique.
Dr.Jay Granzow and Dr. Isao Koshima performing lymphaticovenous anastomoses in Japan
Several small incisions in the affected arm or leg are all that is required for surgical access for the procedure.
The technique relys on the use of supermicrosurgery to connect the lymphatic channels directly to the nearby veins. The diameter of the lymphatic channels is tiny, on the order of 0.1 mm to 0.3 mm in diameter. In comparison, the lead from a standard mechanical pencil is several times as wide. Specialized techniques are employed in which surgeons use superfine surgical suture and a high power microscope.
It is thought that not all of the lympaticovenous connections remain open after the surgery, which may account for the mixed results sometimes seen in the surgery. Dr. Granzow seeks to make between 10 and 13 lymphatic to venous connections during a typical surgery, with the goal of achieving several connections which remain open in the long term.
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