LVA · VLNT · Complete Decongestive Therapy — Comprehensive lymphedema management by Pune's only dedicated lymphedema surgeon, Dr. Pranav Thusay.
Lymphedema is a chronic condition of abnormal swelling caused by damage or obstruction to the lymphatic system — most commonly after cancer treatment (surgery, radiation), infection, or trauma. The limb becomes persistently swollen, heavy and uncomfortable, and if left untreated, progresses to skin changes, recurrent infections and reduced quality of life.
As Pune's only Lymphedema Surgeon, Dr. Thusay offers the complete spectrum of care — from conservative therapy to cutting-edge microsurgical intervention. Unlike most centres in India, PeriFORMÉ can offer both LVA and VLNT — the two gold-standard surgical procedures for lymphedema.
Lymphaticovenular Anastomosis (LVA) is one of the most refined procedures in all of surgery — a supermicrosurgical bypass in which functioning lymphatic vessels, often less than 0.8 mm in diameter, are joined directly to tiny veins under a high-magnification operating microscope. The result is a new, permanent drainage pathway: lymph fluid that previously pooled in the arm or leg is rerouted into the venous circulation and carried away naturally by the body.
At PeriFORMÉ, LVA begins with precise mapping of the lymphatic channels using ICG (indocyanine green) lymphography, which shows in real time which vessels are still functioning. Small incisions — usually 2–3 cm each — are made over the selected sites, the lymphatic vessel and a nearby venule are prepared, and the two are joined with sutures finer than a human hair (11-0 or 12-0 nylon). Multiple anastomoses are typically created in a single sitting for maximum effect.
Because the incisions are small and no muscle is disturbed, LVA is performed as a day-care or one-night procedure, often under local or regional anaesthesia. Most patients return to routine activity within days. LVA delivers the best results in early-to-moderate lymphedema (ISL Stage I–II), where it can significantly reduce limb volume, cut the frequency of cellulitis episodes, and in many patients reduce dependence on compression garments. Read more on our dedicated LVA Surgery page.
Vascularized Lymph Node Transfer (VLNT) takes a different approach: instead of bypassing the blockage, it replaces what was lost. A small cluster of healthy lymph nodes — together with the artery and vein that keep them alive — is harvested from a donor site such as the groin, the neck (supraclavicular region), or the omentum inside the abdomen, and transplanted to the affected limb using free-flap microsurgical technique.
Once connected to the local blood supply, the transferred nodes act as a living pump. They absorb excess lymphatic fluid, and over the following months they release growth factors that stimulate lymphangiogenesis — the sprouting of new lymphatic channels around the transplant. VLNT is particularly valuable for moderate-to-advanced lymphedema (ISL Stage II–III), where the native lymphatics are too damaged for LVA alone, and for patients with recurrent cellulitis.
VLNT is a more involved operation than LVA — it typically requires 2–5 days in hospital and careful donor-site selection to avoid causing lymphedema elsewhere, which is why it should only be performed by a surgeon with dedicated free-flap microsurgery training. Dr. Thusay's fellowship training in reconstructive microsurgery in Bern, Switzerland and over 1,000 microsurgical reconstructions underpin PeriFORMÉ's VLNT programme. In selected patients, LVA and VLNT are combined, or VLNT is paired with breast reconstruction after mastectomy. Learn more on the VLNT Surgery page.
Complete Decongestive Therapy (CDT) is the internationally recognised gold-standard conservative treatment for lymphedema, and it remains the foundation of every treatment plan at PeriFORMÉ — whether or not surgery is performed. CDT has four pillars:
CDT is delivered in two phases: an intensive reduction phase (daily therapy over 2–4 weeks) followed by a life-long maintenance phase with garments, self-massage and monitoring. For patients undergoing LVA or VLNT, CDT before and after surgery measurably improves surgical outcomes. Our trained lymphedema therapists provide the full programme — MLD, bandaging, garment measurement and fitting, and physiotherapy — detailed on the CDT page.
Lymphedema surgery is supermicrosurgery — operating on vessels under 0.8 mm demands training, equipment and case volume that very few centres in India possess. Dr. Pranav Thusay is Pune's only dedicated lymphedema surgeon, and PeriFORMÉ is among the few centres in the country offering LVA, VLNT and full CDT under one roof, so your treatment is chosen for your stage of disease — not limited by what a centre happens to offer.
Explore the full range of treatments on our Services page, or book a consultation at our Baner or Sasoon Road clinic.
The measure of lymphedema treatment is not a scan or a chart — it is a sleeve that finally fits, a wedding attended without a compression garment, a night without the fear of another cellulitis admission. Patients treated at PeriFORMÉ consistently report the outcomes that matter: visible and measurable reduction in limb volume, dramatically fewer infections, lighter and softer limbs, and the confidence to travel, work and dress freely again.
Typical journeys we see: a breast-cancer survivor whose early Stage II arm lymphedema was treated with multi-site LVA and who now manages with only a night garment; a filariasis patient whose recurrent leg cellulitis — three hospital admissions a year — stopped after combined VLNT and CDT; a young woman with primary lymphedema who, after staged treatment, returned to full-time work without daily bandaging. Every case is documented with standardised limb measurements so progress is objective, not anecdotal.
You can view before-and-after results in our patient gallery and read patient experiences on our testimonials section. International patients travel to Pune for lymphedema surgery through our medical tourism programme.
Lymphedema is a chronic condition with no complete cure, but it is highly manageable. CDT (conservative therapy) controls the condition effectively. LVA and VLNT surgery can significantly reduce the swelling and in many cases reduce or eliminate dependence on compression garments.
LVA (Lymphaticovenular Anastomosis) is a microsurgical procedure where blocked lymphatic channels are directly connected to nearby small veins using sutures thinner than a human hair. This creates a bypass, allowing lymph fluid to drain through the venous system, reducing swelling in the limb.
LVA is most effective in early-to-moderate lymphedema (ISL Stage I–II) where functioning lymphatic vessels are still present. It is less effective in advanced, chronic lymphedema (Stage III) where fibrosis has occurred. Dr. Thusay assesses candidacy with lymphoscintigraphy (lymphatic mapping).
LVA creates a bypass by joining existing lymphatics to veins. VLNT transplants healthy lymph nodes from another part of the body to the affected area, essentially 'transplanting' a functional lymph node complex. Each is indicated for different stages and types of lymphedema.
Early intervention gives the best outcomes. Even before visible swelling appears, prophylactic measures and CDT can prevent progression. Once swelling is present, early LVA surgery (within 1–2 years of onset) has the best outcomes.
CDT is effective for controlling lymphedema and must be continued long-term regardless of surgery. For patients with early-stage lymphedema or those not suitable for surgery, CDT alone is the primary treatment. Surgery and CDT are complementary, not mutually exclusive.
LVA is often performed as a day surgery or 1-night admission. VLNT requires 2–5 days of hospitalisation as it is a more complex microsurgical flap procedure. Dr. Thusay will clarify the admission plan during your consultation.
The anastomoses created during LVA remain patent long-term in most patients. Clinical studies show sustained reduction in limb volume and cellulitis episodes at 5+ years post-surgery. Regular follow-up and continued use of compression garments are important.
Pune's only dedicated Lymphedema Surgeon — the right expertise for the right result.