Surgeon from Austria and Italy visiting Prof Xie at Hangzhou qiushi hosptial- LVA-AD Live surgery
June 1, 2024: The First International Symposium on the Application of Cervical LVA in Alzheimer’s Disease Treatment Held in Hangzhou
The inaugural international symposium on the application of deep cervical lymphovenous anastomosis (LVA) for Alzheimer’s disease (AD) treatment was held in Hangzhou, gathering experts from overseas and regions including Hong Kong, Macau, and Taiwan. Distinguished participants included JP. Hong (Ulsan University, South Korea), Tobias Hirsch and Maximilian Kueckelhaus (University of Münster, Germany), Luccie Wo (Yale University, USA), Johnson Chia-Shen (Chang Gung Memorial Hospital, Taiwan), Li Gang and Tor Chiu (Chinese University of Hong Kong), and Matt Lemay (VP, MMI Microsurgery Robotics). Leading Chinese microsurgery experts such as Professors Xu Yongqing, Zhao Dewei, Hou Chunlin, Liu Xiaolin, Gu Liqiang, Zhang Yixin, Tang Juyu, Mu Lan, Aihe Maitijiang, Wang Sufu, Wang Huaqiao, Wang Xin, Lu Yun, and Liu Jun, as well as over 100 frontline clinicians from neurology, neurosurgery, and microsurgery fields across China, participated in the discussions. The symposium, chaired by Professor Xie Qingping, explored the clinical application of LVA in AD and advancements in microsurgery and brain function research. The primary academic highlights are summarized below:
1. Overview of Alzheimer’s Disease
With the global aging population increasing, the World Health Organization predicts that by 2030, one in six people will be over 60 years old. Alzheimer's disease, the leading cause of dementia, is anticipated to affect over 10 million people in China by 2030, with global cases reaching 150 million by 2050. AD has become the seventh leading cause of death globally and a significant contributor to healthcare costs.
Despite extensive research into its pathogenesis (e.g., amyloid-beta [Aβ], tau protein, and neuroinflammation), effective treatment options remain scarce. In 2015, Nature published findings on the meningeal lymphatic system, revealing its critical role in clearing interstitial fluid and large molecules such as metabolic and toxic waste via deep cervical lymphatics connected to the peripheral immune system. Animal studies demonstrated that deep cervical lymphatic dysfunction exacerbates AD, providing a pivotal theoretical foundation for surgical intervention.
Professor Xie Qingping pioneered the cervical LVA procedure, enhancing brain lymphatic circulation and clearance capacity. This approach has shown promising outcomes in AD patients and was recognized as one of China’s top seven microsurgery advancements in 2022. It has garnered international attention, with Professor Xie appointed as a visiting professor at the Cleveland Clinic, where his work is regarded as a frontier in supermicrosurgery.
2. Case Studies and Surgical Demonstrations
During the symposium, Professor Xie showcased recent cases, including patients with AD, multiple system atrophy (MSA), and Parkinson’s disease (PD). Attendees observed pre- and post-operative outcomes and participated in a live surgery demonstration. The procedure involved incisions along the posterior edge of the sternocleidomastoid muscle, identifying deep cervical lymphatic vessels and nodes under high-magnification microscopy, and performing lymphatic-to-venous (LVA) and lymph node-to-venous (LNVA) anastomoses.
Case reports from hospitals nationwide (e.g., Jilin University Second Hospital, Hainan Medical University Second Hospital, Xi’an Fengcheng Hospital, Guangdong Chashan Hospital, and Sichuan Modern Hospital) also highlighted various degrees of improvement in patients following the surgery.
3. Academic Presentations
Experts presented groundbreaking research and clinical advancements:
JP. Hong (South Korea): Discussed supermicrosurgery robotics, noting improved suturing precision with robotic assistance, albeit with slightly longer total surgical time compared to manual techniques.
Maximilian Kueckelhaus (Germany): Shared progress in robotic-assisted microsurgery for DIEP flap anastomoses and its integration with augmented reality head-mounted microscopes (BHS), which reduce surgeon fatigue and tremors.
Johnson Chia-Shen (Taiwan): Presented experiences with lymphovenous anastomosis and foundational research linking localized lymphedema to systemic effects.
Li Gang (Hong Kong): Highlighted collaborative efforts with Professor Xie in using cranial bone transport for lymphatic reconstruction.
Zhao Dewei (China): Provided a historical overview of Chinese microsurgery advancements, gaining international acclaim.
Zhang Jing (China): Introduced innovative diagnostic biomarkers for AD, including exosome-based detection methods.
4. Formation of the International LVA Alliance for AD Treatment
The symposium culminated in the establishment of the International LVA Alliance for Alzheimer’s Disease Treatment, led by Professor Xie Qingping. This alliance aims to advance the integration of LVA techniques with neurology and microsurgery, combining global resources for basic research and multicenter clinical trials.
Despite promising outcomes, challenges remain. These include establishing standardized assessment criteria, refining surgical indications and contraindications, enhancing pre- and post-operative evaluation metrics (e.g., imaging and biomarkers), and conducting long-term follow-ups on the effects of non-physiological lymphatic-venous pathways on the brain. Addressing these gaps requires interdisciplinary collaboration and sustained effort.
Conclusion
The innovative application of cervical LVA in treating Alzheimer’s disease represents a significant leap in microsurgery and neurological treatment. While challenges persist, the establishment of the International LVA Alliance marks a pivotal step toward addressing AD, a disease of immense societal burden. Every effort and exploration in this field holds promise and significance for improving patient outcomes and advancing medical science.
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