Recently, the vascular surgery team of Lugang Branch of the First Affiliated Hospital of Xi'an Jiaotong University successfully performed neck deep lymphatic vein anastomosis (LVA) for a 78 year old Alzheimer's disease patient, which has attracted widespread attention. What is the effect of LVA surgery? Is there a new dawn for treating Alzheimer's disease? Regarding this, the reporter interviewed relevant experts. Traditional treatment methods are not very effective. Alzheimer's disease is a complex neurodegenerative disease and the most common form of dementia, mainly occurring in old age or pre old age, hence it is also known as "senile dementia". With the acceleration of population aging and the extension of life expectancy, the number of Alzheimer's disease patients in China continues to grow. According to the "China Alzheimer's Disease Report 2024", there are nearly 17 million patients with Alzheimer's disease and other dementia in China, of which Alzheimer's disease patients account for about 70%. The data shows that among the elderly over 60 years old, the incidence rate of Alzheimer's disease is more than 5%; Among elderly people aged 85 and above, this proportion rises to 30%. Alzheimer's disease is not simply a case of "old confusion", its essence is a brain lesion that leads to a decline in patients' memory, thinking, and cognitive abilities. The early symptoms mainly include memory loss; Gradually developing visual spatial barriers, leading to difficulty finding the way home; Personality can also undergo significant changes. People who used to have a good temper may become irritable and irritable, while those who used to love cleanliness may become less tidy and unkempt. This not only brings great pain to the patients themselves, but also imposes a heavy burden on their families and society. Lu Shaoying, a member of the International Association of Vascular Surgeons and director of the Department of Vascular Surgery at the First Affiliated Hospital of Xi'an Jiaotong University, introduced that in the treatment of Alzheimer's disease, traditional methods mainly rely on medication and psychological therapy. But even with long-term medication, many patients' conditions continue to deteriorate and their quality of life continues to decline. Cognitive training, behavioral intervention, and other psychological therapies, although able to delay cognitive decline to a certain extent, cannot fundamentally change the course of the disease. Therefore, Alzheimer's disease requires new treatment methods. LVA surgery directly addresses the problem of "cerebral endotoxin accumulation". LVA surgery improves cerebrospinal fluid lymphatic drainage, reduces intracranial pressure, promotes the excretion of pathogenic proteins, and delays or even reverses the progression of Alzheimer's disease by establishing a anastomosis channel between lymphatic vessels and veins in the neck. It provides the possibility of surgical intervention for patients in the middle and late stages of the disease. Research has found that Alzheimer's disease is closely related to abnormal deposition of beta amyloid and tau proteins in the brain, while dysfunction of the brain lymphatic system can lead to a decrease in the ability to clear abnormal proteins, resulting in disease. This is receiving increasing attention from clinical physicians and experts in related scientific fields Wang Lin, director of the Department of Neurosurgery at the Aviation General Hospital, pointed out that LVA surgery starts from the pathological mechanism and directly targets the core problem of "cerebral endotoxin accumulation". Wang Lin introduced that LVA surgery was not originally used to treat Alzheimer's disease, but rather a treatment method for neck lymphedema. When treating patients with facial lymphedema, doctors unexpectedly found that the patient's symptoms of Alzheimer's disease had been relieved. This phenomenon has sparked exploration in the medical community of LVA surgery for the treatment of Alzheimer's disease. We found that using large-diameter anastomosis between lymph nodes and veins (such as the internal jugular vein) has a more stable and safer effect Lu Shaoying introduced it. According to data from multiple centers in China, the Mini Mental State Examination (MMSE) score of LVA patients improved by 30% to 50% after surgery, and some patients showed significant improvement in cognitive function compared to before surgery. They could resume activity the day after surgery and the hospitalization period was shortened to 5-7 days. LVA surgery not only brings hope to patients and their families, but also provides new ideas for the medical community to treat Alzheimer's disease. It is expected to become an important supplement to traditional drug treatment and may bring more significant clinical benefits to moderate to severe patients with poor drug efficacy Xing Yan, Vice Chairman and Secretary General of the Neurodegenerative Disease Professional Committee of the Chinese Microcirculation Society, and Director of the Department of Neurology at the Aviation General Hospital, said. In addition, LVA surgery requires deep collaboration between multiple disciplines such as neurology and neurosurgery, which provides useful references for the comprehensive treatment of other complex diseases. The widespread promotion of new technologies still requires caution. Although LVA has shown promising therapeutic effects on Alzheimer's disease, the interviewed doctors are cautious about it. They believe that LVA surgery is still in the clinical exploration stage and is not suitable for all Alzheimer's disease patients, and there are also certain risks involved. The biggest challenge comes from the technical level, as LVA surgery requires extremely high levels of microsurgical skills and anatomical experience from doctors. Lu Shaoying candidly stated that the anatomy of the neck is complex, with clear and slender lymphatic vessels, with a diameter of only 0.3 to 0.5 millimeters. Accurately locating and anastomosing in dense blood vessels and nerve clusters greatly tests the technical level of doctors, and even a slight mistake may cause massive bleeding or nerve damage. At the same time, there is a significant dependence on equipment when performing LVA surgery. Specialized equipment such as fluorescence microscopes are indispensable. However, the cost of a domestically produced equipment exceeds one million yuan, and imported equipment can cost as much as four to five million yuan, making it difficult for most primary hospitals to afford. The key is that there is no unified academic consensus on the core operation of surgery Lu Shaoying explained in detail that taking the selection of anastomotic sites (lymphatic vessels, lymph nodes, or lymph valves) and veins as an example, the standards vary among hospitals and are still in their respective exploration stages. Meanwhile, many interviewed doctors also expressed their concerns that there is still a gap in research on the pathological mechanisms of Alzheimer's disease. The efficacy of LVA surgery originated from accidental discovery. Although it is speculated to be related to accelerating cerebral lymphatic drainage and clearing amyloid protein, the specific mechanism is not clear and lacks rigorous scientific verification. Not all patients are suitable for LVA surgery Lu Shaoying frankly stated that LVA surgery is mainly suitable for patients with moderate to severe Alzheimer's disease, who have ineffective conventional drug treatment, good cardiopulmonary function, and an expected life expectancy of over 5 years. For mild patients who are effectively treated with medication, the potential risks of surgery may outweigh the benefits Lu Shaoying does not recommend this surgery for such patients. He stated that, like other surgical procedures, LVA may result in routine complications such as bleeding, infection, anesthesia accidents, cardiac and respiratory arrest, posing a threat to the patient's life and health. The surgical effect also varies from person to person, and there are unpredictable postoperative reactions. In addition, patients who lack complete examinations or are unable to cooperate with evaluations are also not suitable for surgery. These patients are unable to accurately assess their physical condition and surgical risks, and may encounter unexpected situations during the surgery. At present, LVA surgery is still in the clinical exploration stage, and its long-term efficacy and scope of application still need further verification Xing Yan reminds patients, their families, and doctors to maintain a rational and cautious attitude towards LVA surgery. In the future, more clinical research and case accumulation are still needed, combined with basic research, to clarify the optimal indications for surgery, optimize the surgical process, and further reduce surgical risks. Overall, as an emerging therapy, LVA requires more standardized multicenter research and clinical practice support Xing Yan said. (New Society)