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Intracranial Lymphatic Circulation DisorderCLVA-CLNA-ICLCNCT07328386

Effect of Cervical Lymphaticovenous and Lymph Node-to-Vein Anastomosis in Patients With Intracranial Lymphatic Circulation Disorder

A study testing Cervical Lymphaticovenous and Lymph Node-to-Vein Anastomosis in people with Intracranial Lymphatic Circulation Disorder and Alzheimer's Disease, run by Hong Joonpio at 1 site in South Korea.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

This study is a single-center, prospective clinical trial designed to evaluate the therapeutic effects of lymphaticovenular anastomosis (LVA) and lymph node-venous anastomosis (LNVA) in patients with intracranial lymphatic circulation disorders. Read more about this study

Who is it for?
Ages 19 to 100 years
What is being tested?
Cervical Lymphaticovenous and Lymph Node-to-Vein Anastomosis
Type of treatment
Surgery or procedure
Could I receive a placebo?
No, everyone receives an active treatment
How many people
114 participants
Where
1 siteSouth Korea
Study dates
20 Feb 2025to 31 Dec 2026
Phase
Interventional
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 19 to 100 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Patients aged 19 years or older who are diagnosed with intracranial lymphatic circulation disorder based on neurological evaluation.
  • Global Deterioration Scale (GDS) score between 3 and 5 at screening.
  • Diagnosis of Alzheimer's disease confirmed by amyloid PET-CT or CSF amyloid testing, showing amyloid accumulation associated with lymphatic circulation disorder.
  • Able to provide written informed consent to participate in the study voluntarily.

Who cannot join

  • Unable to undergo follow-up evaluation for at least 12 months after surgery.
  • Diagnosed with vascular dementia.
  • Presence of structural brain disease other than intracranial lymphatic circulation disorder.
  • Known hypersensitivity to indocyanine green (ICG).
  • Uncontrolled systemic medical conditions such as severe cardiopulmonary, renal, hepatic, or endocrine disorders.
  • History of previous neck surgery.
  • Refusal to participate or failure to provide informed consent.
  • Determined by the principal investigator to be unsuitable for participation due to any other clinical reason.

Trial locations and contacts

1 site in 1 country. Contact the study team or a site near you to ask about taking part.

Jin geon Guen, MD, PhD contact

+82230103600

ione2bbest@naver.com

South Korea1 site, 1 recruiting
  • Asan Medical Center

    Seoul

    Joonpio Hong, MD, PhD, +821074753606, joonphong@amc.seoul.kr

    Jin geon Hong, Guen, MD, PhD, ione2bbest@naver.com

    Recruiting

Other trials in South Korea

About this study

Official title: Effect of Cervical Lymphaticovenous Anastomosis and Cervical Lymph Node to Vein Anastomosis for the Patient With Intracranial Lymphatic Circulation Disorder

This study is a single-center, prospective clinical trial designed to evaluate the therapeutic effects of lymphaticovenular anastomosis (LVA) and lymph node-venous anastomosis (LNVA) in patients with intracranial lymphatic circulation disorders. Following voluntary written informed consent, screening assessments will be performed in accordance with the clinical trial protocol. Eligibility will be determined based on the predefined inclusion and exclusion criteria, and eligible subjects will be enrolled in the study. Enrolled participants will undergo cognitive function assessments at baseline (pre-surgery) and at 1, 3, 6, 9, 12, 18, and 24 months postoperatively for follow-up. Cognitive evaluations will not be additionally performed for research purposes but will be conducted in accordance with the existing clinical care schedule and standard treatment guidelines.

Read the detailed description

There are several theories regarding the causes of mild cognitive impairment (MCI) and dementia, and one of the commonly proposed mechanisms involves the accumulation of amyloid, a metabolic waste product, within the brain parenchyma. This accumulation is thought to result from impaired clearance of waste from the brain. Accordingly, impaired function of the brain's waste drainage system may contribute to the development of cognitive symptoms.

Because waste clearance from the brain occurs through lymphatic pathways, dysfunction of lymphatic circulation has been identified as an important contributing factor to MCI and dementia. However, due to the minute diameter of lymphatic vessels-typically less than 1 mm-direct therapeutic interventions targeting lymphatic function have long remained unexplored.

Recent advances in supermicrosurgical techniques have enabled procedures on lymphatic vessels as small as 0.2-0.3 mm, leading to the development of novel treatments for lymphatic circulation disorders. For example, patients with upper or lower extremity lymphedema, a representative condition of lymphatic dysfunction, have shown significant improvement following lymphaticovenular anastomosis (LVA) or lymph node-venous anastomosis (LNVA).

Lymphedema results from obstruction or damage to lymphatic pathways, causing the accumulation of lymphatic fluid in tissues. LVA and LNVA are microsurgical procedures that create new bypass routes by connecting lymphatic vessels or lymph nodes directly to adjacent veins, thereby allowing lymphatic fluid to drain into the venous system and re-enter systemic circulation. These procedures have been performed for more than two decades, with excellent therapeutic outcomes reported over the past five years. At Asan Medical Center, more than 100 such procedures are successfully performed annually.

Furthermore, based on the same principle applied in limb lymphedema, recent case-level studies have suggested that performing LVA or LNVA in lymphatic pathways or lymph nodes responsible for cerebral waste clearance may improve degenerative neurological conditions, including Alzheimer's disease. Based on this accumulated knowledge and surgical expertise, cervical lymphaticovenular anastomosis and cervical lymph node-venous anastomosis will be performed to connect lymphatic vessels and lymph nodes involved in cerebral lymphatic drainage to adjacent veins.

It is hypothesized that this procedure may help slow disease progression, preserve quality of life, and potentially improve cognitive function in patients with mild cognitive impairment or dementia.

Being tested
Cervical Lymphaticovenous and Lymph Node-to-Vein Anastomosis
Keywords
Lymphaticovenous Anastomosis (LVA), Lymph Node-to-Vein Anastomosis (LNVA), Amyloid Clearance, Cognitive Function, Dementia
Medical subject headings
Alzheimer Disease, Dementia

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Cervical Lymphaticovenous and Lymph Node-to-Vein AnastomosisProcedure or surgery

    This microsurgical procedure involves connecting the cervical lymphatic vessels and lymph nodes to adjacent veins to enhance lymphatic drainage from the brain. The purpose of the surgery is to reduce amyloid accumulation and improve cognitive function in patients with intracranial lymphatic circulation disorders.

    Before the operation, ultrasound imaging is used to identify the lymphatic vessels, lymph nodes, and nearby veins. A small incision of approximately 2-3 cm is made along the sternocleidomastoid muscle. Indocyanine green (ICG) dye is injected to visualize lymphatic flow, and under microscopic guidance, the lymphatic structures are anastomosed to the adjacent veins. Finally, the incision is closed with adhesive, and no postoperative drainage is required.

Study groups in NCT07328386
Study groupRoleWhat they receive
Surgical Intervention GroupExperimentalParticipants in this group will undergo cervical lymphaticovenous anastomosis (LVA) and cervical lymph node-to-vein anastomosis (LNVA). The procedure connects cervical lymphatic vessels and lymph nodes to adjacent veins to facilitate lymphatic drainage from the brain and reduce amyloid accumulation associated with intracranial lymphatic circulation disorder in patients with Alzheimer's disease.
Receives: Procedure: Cervical Lymphaticovenous and Lymph Node-to-Vein Anastomosis
Control GroupNo interventionParticipants in this group will receive standard medication therapy only, following the hospital's routine treatment guidelines for Alzheimer's disease.

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Change in Global Deterioration Scale (GDS) Score

    Cognitive decline will be assessed using the Global Deterioration Scale (GDS). The GDS score ranges from 1 to 7, with higher scores indicating more severe cognitive impairment. The outcome measure is the change in GDS score from baseline to postoperative follow-up visits. Scores will be compared between the surgical (LVA + LNVA) group and the medication-only control group.

    Measured: From preoperative baseline to postoperative Months 1, 3, 6, 9, 12, 18, and 24

  2. Change in Clinical Dementia Rating - Sum of Boxes (CDR-SB) Score

    Dementia severity will be evaluated using the Clinical Dementia Rating - Sum of Boxes (CDR-SB).

    CDR-SB scores range from 0 to 18, with higher scores indicating more severe cognitive impairment The outcome measure is the change in CDR-SB score from baseline to postoperative follow-up visits.

    Scores will be compared between the surgical (LVA + LNVA) group and the medication-only control group.

    Measured: Preoperative baseline and postoperative Month 12

  3. Change in Korean Mini-Mental State Examination (K-MMSE) Score

    Cognitive function will be assessed using the Korean Mini-Mental State Examination (K-MMSE).

    K-MMSE scores range from 0 to 30, with higher scores indicating better cognitive function.

    The outcome measure is the change in K-MMSE scores from the preoperative baseline to 12 months after surgery.

    Scores will be compared between the surgical (LVA + LNVA) group and the medication-only control group.

    Measured: From preoperative baseline to postoperative Months 1, 3, 6, 9, 12, 18, and 24

  4. Change in Montreal Cognitive Assessment (MoCA) Score

    Cognitive performance will be assessed using the Montreal Cognitive Assessment (MoCA).

    MoCA scores range from 0 to 30, with higher scores indicating better cognitive performance.

    The outcome measure is the change in MoCA scores from the preoperative baseline to 12 months after surgery.

    Scores will be compared between the surgical (LVA + LNVA) group and the medication-only control group.

    Measured: Preoperative baseline; postoperative Day 4; Months 1, 3, 6, 9, 12, 18, and 24

  5. Change in Seoul Neuropsychological Screening Battery (SNSB) Score

    Cognitive function will be assessed using the Seoul Neuropsychological Screening Battery (SNSB), a comprehensive neuropsychological test battery evaluating multiple cognitive domains including attention, language, visuospatial function, memory, and executive function.

    SNSB provides domain-specific and composite scores, with higher scores generally indicating better cognitive performance, depending on the specific subtest.

    Score ranges differ across subtests within the SNSB. The outcome measure is the change in SNSB scores from the preoperative baseline to postoperative follow-up assessments.

    Scores will be compared between the surgical (LVA + LNVA) group and the medication-only control group.

    Measured: Preoperative baseline; postoperative Months 6, 12, and 24

Secondary outcomes (3)
  1. Incidence of Surgical Complications and Adverse Events

    Surgical complications and adverse events will be monitored throughout the study period to evaluate the safety of cervical lymphaticovenous and lymph node-to-vein anastomosis.

    Complications may include postoperative infection, wound issues, bleeding, lymphatic leakage, anesthetic complications, or other procedure-related adverse events.

    Adverse events will be recorded according to clinical severity and temporal relationship to the intervention.

    The outcome measure is the incidence and type of complications occurring during the follow-up period.

    Measured: From the day of surgery through postoperative Month 24

  2. Change in Amyloid-Related Blood Biomarkers

    The outcome measure is the change from the preoperative baseline to postoperative follow-up assessments in pre-specified amyloid-related blood biomarkers (e.g., amyloid-beta-related markers). Changes in amyloid-related blood biomarkers will be compared between the surgical (LVA + LNVA) group and the medication-only control group.

    Measured: Preoperative baseline; postoperative Months 1, 3, 6, 12, and 24

  3. Change in Blood Biomarkers of Neurodegeneration

    The outcome measure is the change from the preoperative baseline to postoperative follow-up assessments in pre-specified blood biomarkers of neurodegeneration (e.g., phosphorylated tau). Changes in neurodegeneration-related blood biomarkers will be compared between the surgical (LVA + LNVA) group and the medication-only control group.

    Measured: Preoperative baseline; postoperative Months 1, 3, 6, 12, and 24

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted9 Jan 2026
  2. Study start20 Feb 2025
  3. Primary completion31 Dec 2026 (estimated)
  4. Study completion31 Dec 2026 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Non-randomised
Intervention model
Parallel groups
Model description
Participants will be assigned to one of two parallel groups: 1. a surgical intervention group receiving cervical lymphaticovenous and lymph node-to-vein anastomosis plus standard medical therapy, and 2. a control group receiving standard medical therapy alone. The two groups will be followed over the same time points to compare changes in cognitive and clinical outcomes.
Masking
None (open label)
Enrolment
114 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT07328386
Sponsor's protocol ID
2025-0033
Acronym
CLVA-CLNA-ICLC
Status last verified
Jan 2026
First submitted
25 Nov 2025
Last updated
9 Jan 2026
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Questions about this trial

What is this clinical trial studying?

A study testing Cervical Lymphaticovenous and Lymph Node-to-Vein Anastomosis in people with Intracranial Lymphatic Circulation Disorder and Alzheimer's Disease, run by Hong Joonpio at 1 site in South Korea.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 4 inclusion and 8 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: looking for participants now, as of the sponsor's last update on 9 Jan 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in South Korea. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Jin geon Guen, MD, PhD (+82230103600, ione2bbest@naver.com), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Change in Global Deterioration Scale (GDS) Score (time frame: From preoperative baseline to postoperative Months 1, 3, 6, 9, 12, 18, and 24). The study lists 5 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 9 Jan 2026.

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