Rethinking cervical deep lymphovenous anastomosis in Alzheimer's disease: problems and prospects

Deep cervical lymphovenous anastomosis (DCLVA) has been proposed as a novel surgical strategy to promote brain waste clearance in Alzheimer's disease (AD), inspired by advances in glymphatic and meningeal lymphatic research. Early reports suggested possible cognitive benefits, yet the scientific basis of this approach remains controversial.

This Perspective critically examines the mechanistic rationale, anatomical limitations, and methodological shortcomings underlying DCLVA. The pressure disparity between cervical lymphatic and venous systems challenges the physiological feasibility of the procedure, while existing studies lack randomized design, biomarker validation, and control for anesthesia-related confounding. Ethical and translational considerations further underscore the need for rigorous preclinical and clinical evaluation before any clinical adoption.

While DCLVA reflects an innovative attempt to translate lymphatic biology into surgical therapy, its current theoretical and empirical foundation is insufficient. A shift toward mechanistic validation, objective imaging biomarkers, and non-invasive modulation of lymphatic function is warranted before DCLVA can be considered a viable therapeutic option for AD.