The Efficacy of Calcium Dobesilate Alone or with Vascularized Lymph Node Transfer in Lymphedema Treatment: A Preliminary Study.

Abstract

Lymphedema remains an uncurable disease, despite recent advancements in pharmacological research and microsurgical techniques. Calcium dobesilate is an angioprotective and antioxidant drug. This study aimed to compare the use of calcium dobesilate alone or in combination with vascularized lymph node transfer in the treatment of lymphedema. Twenty-four rats were divided into four groups. In all groups, a lymphedema model was created in the left lower limb by excision of the inguinal and popliteal lymph nodes, followed by irradiation. In group 1, no treatment was performed. In group 2, calcium dobesilate was given. In group 3, vascularized lymph node transfer was performed. In group 4, calcium dobesilate was given with vascularized lymph node transfer. Ankle circumference measurement and lymphoscintigraphy were performed at weeks 5 and 9. All rats were sacrificed at week 9, and tissue samples were evaluated histologically and immunohistochemically. At the end of week 9, all parameters of ankle circumference measurements, lymphoscintigraphy counts, subcutaneous fat deposition, fibrosis, inflammation, and lymphatic vessel structural changes were the best in group 4 and the worst in group 1. The untreated group (group 1) had significantly higher ankle circumference measurements than the treated groups (groups 2, 3, 4) (p < 0.001). Adipose tissue thickness and inflammatory cell count were significantly lowest in group 4 (p < 0.001 and p < 0.001, respectively). The use of calcium dobesilate in combination with vascularized lymph node transfer in the treatment of lymphedema could be more effective than the use of these methods alone. In clinical practice, calcium dobesilate could be incorporated into the treatment protocol to enhance the efficacy of vascularized lymph node transfer in lymphedema.