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In conventional LVA, superficial lymphatic vessels are used for anastomosis, but its treatment efficacy would be minimum when superficial lymphatic vessels are severely sclerotic. Theoretically, deep lymphatic vessels can be used for LVA, but no clinical case has been reported regarding deep lymphatic vessel\u2010to\u2010venous anastomosis (D\u2010LVA). We report a breast cancer\u2010related UEL case treated with D\u2010LVA, in which a less\u2010sclerotic deep lymphatic vessel was useful for anastomosis but superficial lymphatic vessels were not due to severe sclerosis. A 62\u2010year\u2010old female suffered from an 18\u2010year history of compression\u2010refractory right UEL after right breast cancer treatments, and underwent LVA under local infiltration anesthesia. Because superficial lymphatic vessels found in surgical fields were all severely sclerotic, a deep lymphatic vessel was dissected at the cubital fossa. A 0.50\u2010mm deep lymphatic vessel running along the brachial artery was supermicrosurgically anastomosed to a nearby 0.40\u2010mm vein. At postoperative 12 months, her right UEL index decreased from 134 to 118, and she could reduce compression frequency from every day to 1\u20132 days per week to maintain the reduced lymphedematous volume. D\u2010LVA may be a useful option for the treatment of compression\u2010refractory UEL, when superficial lymphatic vessels are severely sclerotic. \u00a9 2015 Wiley Periodicals, Inc. 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