Why Deep Cervical Lymphovenous Anastomosis for Alzheimer Disease Lacks Scientific Foundation

Deep cervical lymphovenous anastomosis (DCLVA) has been rapidly adopted as a surgical treatment for Alzheimer disease (AD), based on the hypothesis that enhancing cervical lymphatic drainage may promote glymphatic clearance of neurotoxic proteins. By mid-2025, an estimated 382 hospitals in China had performed the procedure before any randomized controlled trial was completed, prompting China's National Health Commission to prohibit its clinical use on the grounds of insufficient evidence. That prohibition addressed the absence of clinical trial data but did not articulate a specific physiological objection. Following a recent critical review of lymphovenous anastomosis in the lower extremity, the senior author investigated the status of this technique in the craniofacial region and found that its dominant application is not for head and neck lymphedema but for AD. This review identifies fundamental scientific gaps in the rationale for DCLVA in AD. The target pathology-cervical lymphatic insufficiency-has never been confirmed in living patients with AD. Preclinical evidence is contradictory: modulating dural lymphatic vessels in either direction does not alter amyloid pathology in mouse models. No study has controlled for confounding anesthetic effects. No standardized surgical protocol exists. Hemodynamic conditions at the anastomotic site during supine sleep-when glymphatic clearance is most active-have never been measured. Serious adverse events have already been reported. These gaps represent deficiencies in the fundamental science that must be resolved before clinical investigation can be justified.