PRMA - Lymphovenous Anastomosis

Lymphaticovenous Anastomosis (LVA)

What is Lymphaticovenous Anastomosis?

Lymphovenous Anastomosis (LVA), or “lymphatic bypass surgery”, is a minimally invasive microsurgical procedure designed to treat lymphedema by improving lymphatic drainage. 

Using microsurgical techniques, surgeons reroute excess lymphatic fluid into the body’s venous system. By connecting tiny lymphatic vessels (which carry fluid) directly to small veins (which drain it), LVA helps reduce swelling and prevent fluid buildup. This advanced technique is most effective when performed early in the course of lymphedema and can dramatically improve both quality of life and limb appearance.

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Key Information

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Minimally invasive: Uses tiny incisions and microscopes to reroute lymph flow.
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Best for early-stage cases: Most effective before significant tissue damage.
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Same-day surgery: No hospital stay, go home the same day.

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Eases swelling and heaviness: Improves circulation and reduces fluid buildup.

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May reduce need for therapy: Can lessen reliance on compression over time.

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No drains needed: Low risk, minimal recovery.

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Can be combined: Works alongside lymph node transfer for added benefit.

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Insurance-friendly: Often covered, our team helps with approvals.

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Quality of life boost: Helps patients feel more comfortable and confident.

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What to Expect During Surgery

Lymphovenous Anastomosis is a delicate outpatient surgery that uses microsurgical techniques to create new drainage routes for lymphatic fluid. During surgery, your PRMA microsurgeons use specialized microscopes to locate tiny, functioning lymphatic vessels, sometimes less than 0.5 millimeters in diameter. Once identified, these lymphatic channels are carefully connected, or “anastomosed,” to equally small nearby veins. This connection forms a lymphaticovenous bypass, allowing fluid that would normally get trapped to flow directly into the venous system and circulate naturally.

Several bypasses are usually performed in one procedure, depending on the severity and location of your symptoms. The surgery involves only small 1–2 cm incisions, typically placed near the wrist, forearm, ankle, or calf. Because the technique is so precise and minimally invasive, LVA does not require surgical drains, and most patients return home the same day. 

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Recovery and Timeline

  • Week 1:

    Mild swelling and bruising near the incision sites are common. You’ll be encouraged to elevate the affected limb and limit strenuous movement. Most patients feel well enough to resume light activities within a few days.

  • Week 2:

    Swelling typically begins to decrease. You may notice subtle changes in how your limb feels, less heaviness, tightness, or discomfort. Stitches are removed after 2 weeks, and compression and or therapy is resumed, without restriction. This can then be reduced as symptoms improve.

  • Week 3-4:

    Continued improvement in symptoms. Many patients report feeling “lighter” in the affected arm or leg. Most can return to normal daily activities, though high-impact exercise should still be avoided unless cleared by your surgeon. 

  • Week 5-6:

    By now, most of the swelling related to the surgery has resolved. If LVA was effective, limb volume may begin to reduce, and compression needs may start to ease. PRMA may recommend a follow-up visit to assess progress and discuss the next steps.

Am I a Candidate for Lymphaticovenous Anastomosis?

Because LVA targets functioning lymphatic vessels, it’s especially beneficial in early-stage lymphedema, before the lymph system becomes too damaged or scarred. For patients with more advanced cases, LVA may be paired with additional techniques like vascularized lymph node transfer for greater benefit. 

To determine whether you are a candidate for an LVA procedure, our team must first perform a diagnostic study called ICG lymphangiography to identify locations of lymphatic flow blockage in the arm that would be circumvented during the procedure.


You may be a candidate for Lymphovenous Anastomosis if:

  • Your lymphedema is early-stage (Stage 0–2)
  • You’ve had lymph node removal or radiation and now notice swelling
  • You’re seeking a minimally invasive option with little downtime
  • You’d like to reduce dependence on compression garments or therapy
  • You’re motivated to intervene early and protect your long-term function

While these criteria can help guide decision-making, it’s important to remember that nothing replaces a personalized consultation. Our board-certified surgeons carefully evaluate each patient to determine whether LVA or another treatment option is most appropriate for your specific condition and goals.

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Find Your Surgeon

Lymphovenous anastomosis requires an exceptional level of microsurgical precision and specialized training. At PRMA, our surgeons are nationally recognized for their expertise in advanced lymphatic surgery and reconstructive microsurgery.

Patients travel to PRMA from across Texas, the U.S., and around the world to receive individualized care focused on long-term function, symptom relief, and quality of life. Every treatment plan is developed collaboratively, with careful consideration of your diagnosis, stage of lymphedema, and overall health.
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Dr. Anton Fries
Board-Certified Plastic Surgeon specializing in advanced lymphatic surgery and reconstructive microsurgery

Will Insurance Cover Lymphaticovenous Anastomosis?

Insurance coverage for lymphaticovenous anastomosis can vary, and not all providers cover this procedure. Coverage often depends on factors such as medical necessity, lymphedema stage, prior treatments, and individual plan policies.

PRMA works closely with patients and insurance providers to help clarify coverage, obtain necessary documentation, and explore all available options. Our goal is to reduce uncertainty and support access to care whenever possible.

For more information, visit Insurance FAQs in the patient resource center or speak with our care team during your consultation.

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Preparing for Surgery

Whether you’re local or traveling in, we’re here to make your experience as smooth and stress-free as possible. Explore what to expect before surgery and how to plan your trip to PRMA.

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Frequently Asked Questions

Is LVA a cure for lymphedema?

LVA is not a cure, but it can significantly reduce symptoms and slow the progression of lymphedema—especially when performed in the early stages. Many patients experience lasting improvements in swelling, comfort, and mobility.

Will I need physical therapy after LVA?

Yes, physical therapy is often recommended both before and after LVA to help prepare the lymphatic system for surgery and support healing afterward by promoting fluid movement and maintaining results. Your PRMA team will coordinate with certified lymphedema therapists as part of your personalized care plan.

Will I still need to wear compression garments after surgery?

Most patients continue using compression garments after LVA, especially during early recovery. However, depending on symptom improvement and their surgeon's recommendations, some may eventually reduce their use.

How long does the procedure take?

LVA typically takes around 2 hours, depending on the number of bypasses created and the complexity of your case. Since it’s an outpatient procedure, most patients return home the same day.

Can LVA be combined with other lymphedema treatments?

Yes. LVA can be combined with vascularized lymph node transfer (VLNT) or other techniques to enhance results for patients with more advanced lymphedema or less responsive lymphatic vessels.

Find Out if LVA is Right for You.

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