‘Microsurgery’ to relieve swollen limb condition that could change patients’ lives is being rejected by the NHS, charity claims

People with swollen limbs are being denied a revolutionary operation that could change their lives by the NHS, a charity claims.

This condition, lymphedema, causes fluid to build up in the body’s lymphatic vessels that fight infection, leaving patients with heavy, painful arms and legs.

The operation requires complex microsurgery using powerful microscopes to connect the damaged lymphatic system to the veins and drain the excess fluid.

In nearly nine out of ten patients who undergo a treatment called lymphovenular anastomosis (LVA), the swelling disappears permanently.

Although lymphoedema affects around 300,000 Britons (the most common cause is cancer treatment), few have access to the £15,000 procedure through the NHS.

‘Lymphedema is severely under-resourced,’ says Karen Friett, chief executive of the charity Lymphoedema Support Network. ‘More investment is needed to enable people to live well with the condition – and the option of offering LVA as part of a care package for those it is suitable for would be welcome.’

Alex Ramsden, a plastic surgeon at the Oxford Lymphoedema Practice, who pioneered the operation in the UK, agrees. ‘It could help so many people,’ he says. ‘We need to put as much pressure on the powers that be, political and economic, to get the NHS to do it.’

Lymphedema occurs when the lymphatic system, a network of channels that transports fluid through the body to fight infection, cannot drain properly. A family history of the condition can increase your risk of developing it, as can infection or obesity.

Parts of the lymphatic system are often removed during cancer surgery to reduce the risk of spreading the disease. The system can also be damaged by radiation therapy, often leading to fluid retention and swelling in the arms and legs.

When this happens, wearing clothes, watches and jewelry can become uncomfortable and patients’ freedom of movement can be restricted, and they may even need to be hospitalized.

The majority of NHS lymphedema patients receive decongestive therapy – which consists of exercises, massage and compression bandages – to reduce the severity of the condition. However, it is not a cure.

The LVA procedure is performed by suturing the blocked portion of the lymphatic system to a vein under a high-powered microscope. The sutures are one-fifth the size of a human hair and are used to limit the amount of fluid that flows into the veins.

It is effective for 85 per cent of patients and in April last year NICE, the NHS spending regulator, concluded that it ‘has the potential to improve a person’s quality of life and may have other benefits, such as a reduction in hospital admissions’.

However, due to its high cost, it is currently only offered to NHS patients at risk of lymphoedema following breast cancer surgery or as part of research studies.

Fred Rogers, 76, from Birmingham, a keen hill walker, had the treatment when he developed lymphoedema in his ankles six months after prostate cancer surgery

Not all patients with lymphedema can receive an LVA. The intensive procedure is considered too risky for older or seriously ill patients.

However, experts say eligible NHS patients should be offered the procedure if they do not 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 delivers long-term benefit and allows people to get on with their lives.’

Fred Rogers, 76, from Birmingham, a keen walker, had the treatment when he developed lymphoedema in his ankles six months after prostate cancer surgery in 2022.

Decongestive lymphatic therapy had little effect, he claims. But after his eight-hour LVA procedure last February, he says: ‘It was a brilliant operation. I can honestly say it changed my life.’