People with a swollen limb condition are being denied a revolutionary operation by the NHS that could transform their lives, a charity has claimed.
The condition, lymphoedema, causes a build-up of fluid in the body’s infection-fighting lymphatic channels that leaves sufferers with heavy and painful arms and legs.
The operation requires intricate microsurgery, using high-powered microscopes, to connect the damaged lymphatic system to veins, to drain the excess fluid.
Nearly nine in ten sufferers who undergo the treatment, called lymphaticovenular anastomosis – or LVA – see their swelling permanently disappear.
However, while lymphoedema affects about 300,000 Britons – the most common cause is cancer treatment – few are able to access the £15,000 procedure on the NHS.
‘Lymphoedema is very under-resourced,’ says Karen Friett, chief executive of the Lymphoedema Support Network charity. ‘More investment is needed to allow people to live well with the condition – and the option to offer LVA as part of a suite of care for those it is suitable for would be welcome.’
Few of the 300,000 Britons who suffer from lymphoedema are able to access the £15,000 ‘microsurgery’ procedure on the NHS
Alex Ramsden, a plastic surgeon at the Oxford Lymphoedema Practice – which has pioneered the surgery in the UK – agrees. ‘It could help so many,’ he says. ‘We need to put as much pressure on the powers that be, politically and economically, to get the NHS to do it.’
Lymphoedema occurs when the lymphatic system, a network of channels that carry fluid around the body to fight infections, cannot drain properly. A family history of the condition can increase the odds of developing it, as can an infection or obesity.
Parts of the lymphatic system are often removed during cancer surgery to reduce the risk of the disease spreading. The system can also be damaged by radiotherapy, often leading to fluid build-ups and swelling in the arms and legs.
When this happens it can make wearing clothing, watches and jewellery uncomfortable, as well as restricting the movement of patients. They may even need to be admitted to hospital.
The majority of NHS lymphoedema sufferers receive decongestive therapy – which involves exercises, massages and compression bandages – to reduce the severity of the condition. However, it is not a cure.
The LVA procedure is carried out by stitching the blocked section of the lymphatic system to a vein under a high-powered microscope. The stitches measure a fifth of the size of a human hair and are used to limit the amount of fluid that ends up in the veins.
It is effective for 85 per cent of patients and, last April, the NHS spending watchdog NICE concluded it has ‘the potential to improve a person’s quality of life and could have other benefits such as reduced hospitalisation’.
However, due to prohibitive cost, it is currently offered only to NHS patients who are at risk of lymphoedema after breast cancer surgery or as part of research trials.
Fred Rogers, 76, from Birmingham, a keen hillwalker, received the treatment when he developed lymphoedema on his ankles six months after a prostate cancer operation
Not all lymphoedema patients can have LVA – the intensive procedure is considered too risky for elderly or severely unwell patients.
However, experts say that NHS patients who are eligible should be offered the procedure if they fail to respond to existing treatments.
‘LVA changes the underlying physiology of the disease,’ says Mr Ramsden. ‘It’s a big upfront investment for the NHS, but it provides a long-term benefit and allows people to get on with their lives.’
Fred Rogers, 76, from Birmingham, a keen hillwalker, received the treatment when he developed lymphoedema on his ankles six months after a prostate cancer operation in 2022.
Decongestive lymphatic therapy had little effect, he claims. But following his eight-hour LVA procedure in February last year, he says: ‘It was a brilliant piece of surgery. I can honestly say it changed my life.’
