Lymphovenous Bypass

Super-microsurgical physiologic lymphatic reconstruction is used to divert the blocked lymphatic fluid into the working nearby veins, thus creating a lymphatic-to-venous bypass, or lymphovenous bypass, using a hand-sewn connection under a microscope called an “anastomosis.”

With this technique, lymph fluid is diverted from the lymphatic system into the venous system upstream of the identified lymphatic blockage, thus providing an outlet for lymph flow leading to decreased fluid stasis and edema. Thus, the lymphatic blockage is bypassed by using the bloodstream as a surrogate conduit. Lymph fluid re-enters the blood circulation peripherally in the extremity, as opposed to centrally via the thoracic duct and attachments to the right subclavian vein, and is of no negative physiologic consequence.

In order to be a candidate for LVA, there must be some remaining functioning lymphatic channels that can be utilized for the bypass. We utilize indocyanine green (ICG) lymphatic mapping to assess whether you have any candidate lymphatic channels.

The best candidates for LVA have fluid-dominant lymphedema, which refers to the ability to move lymph fluid around the affected area.

The ICG mapping can be done separately or at the same time as LVA surgery.

If done separately, we perform ICG lymphatic mapping and then discuss our findings together in clinic. If you are found to be a candidate for LVA, then we will proceed with surgery scheduling.

If done together, we perform ICG mapping under anesthesia and perform LVA immediately.

Incisions are typically 2-3 cm and are are just skin-deep. Many patients report surgery is “painless.” We do request that you refrain from heavy exertion, exercise, and sports for 4 weeks. You may return to desk-type work within 2 days if desired.

Please contact us to for further discussion to determine if you would be a candidate for lymphovenous bypass anastomosis reconstruction of your lymphatic system.