Recently, degeneration of the lymphatic vessels in the extremities with lymphedema has been reported.2,3 Ogata et al11 reported transgenesis of smooth muscle cells. In the extremities with lymphedema, lymphatic vessels are dilated by abnormally increased inner pressure at the early phase. Subsequently, tunica media gets thick due to proliferation of smooth muscle cells and an increase of collagenous fiber, finally leading to complete occlusion.3 These changes do not occur in all of the lymphatic vessels simultaneously. The condition of the lymphatic vessels differs in different regions. Sometimes, different types of lymphatic vessels can be seen in 1 incision site. It is unclear whether lymphatic degeneration occurs gradually or suddenly. In addition, the reason for the different types of lymphatic vessels to appear in 1 region remains unknown. LVA is said to be the most effective when the lymphatic vessel of ectasis type is anastomosed.8 In addition, clarification of the mechanism of lymphatic degeneration or the location of the lymphatic vessels of ectasis type seems essential in the progression of LVA efficacy.