Abstract: Deep cervical lymph–venous anastomosis (LVA) is a surgical procedure initially developed to treat cervical lymphatic obstruction, such as lymphedema, a condition caused by the accumulation of lymphatic fluid due to blocked or damaged lymphatic vessels. In early 2024, Dr. Qingping Xie from Hangzhou Qiushi Hospital, China, and Dr. Wei F. Chen from the Cleveland Clinic, USA, adapted LVA for the treatment of patients with Alzheimer ’s disease (AD). As a VIEWPOINT, they presented a video showcasing the post-surgery cognitive recovery of an 84-year-old AD patient (Xie et al., 2024). Since then, many Chinese hospitals have initiated clinical trials for the treatment of AD (e.g., ChiCTR2400084617, NCT06530732, and NCT06448442) and type 2 diabetes combined with AD (ChiCTR2400093030) using LVA. In June 2024, a letter by Li et al. (2024) demonstrated similar beneficial cognitive effects using a slightly different Cervical Shunting to Unclog Cerebral Lymphatic Systems (CSULS) surgical procedure in AD patients. In a 5-week post-surgery follow-up study of an AD patient who met the diagnostic criteria set by the National Institute on Aging-Alzheimer’s Association, improvements in cognitive function were confirmed. Furthermore, overall brain tau accumulation was reduced (Figure 1), and a significant enhancement in brain glucose metabolism was observed in this patient (Li et al., 2024). More recently, Dr. Mian Guo and team initiated a multicenter, prospective clinical study (ChiCTR2500095309) on LVA for the treatment of moderate to severe AD. To date, the LVA surgical approach has been adopted by over 100 hospitals in China, with thousands of AD patients undergoing the treatment. Many of these patients have reported improvements in AD symptoms on social media. Although anecdotal reports of symptom improvement are widespread on social media, robust analytical data remain limited. As an exploratory approach, LVA has demonstrated explosive growth and continues to attract considerable attention. However, published studies to date have primarily focused on Aβ clearance. This perspective is distinct in that it emphasizes the potential vascular changes that may underlie or modulate the therapeutic effects of LVA.