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Endoluminal recanalization in a patient with phlegmasia cerulea dolens using a multimodality approach-a case report

Stephanie C Lin1, Albeir Mousa, Joshua Bernheim

  • 1Department of Vascular Surgery, New York Presbyterian Hospital, Cornell University, Weill Medical School and Columbia University, College of Physicians and Surgeons, New York, NY 10021, USA.

Vascular and Endovascular Surgery
|May 28, 2005
PubMed

Insights

Phlegmasia cerulea dolens, a severe deep venous thrombosis, requires aggressive treatment. A multimodality endovascular approach using pharmacologic thrombolysis and balloon venoplasty, with argatroban for anticoagulation, successfully treated a patient with heparin-induced thrombocytopenia, salvaging the limb.

Area of Science:

  • Vascular Surgery
  • Interventional Radiology
  • Hematology

Background:

  • Phlegmasia cerulea dolens (PCD) is a critical condition characterized by extensive deep venous thrombosis (DVT).
  • PCD necessitates urgent intervention to prevent limb loss.
  • Managing DVT in patients with heparin-induced thrombocytopenia (HIT) presents a significant clinical challenge.

Observation:

  • A patient presented with extensive iliocaval and femoral DVT, indicative of PCD.
  • The patient had a recent history of heparin-induced thrombocytopenia (HIT), complicating anticoagulation choices.
  • Standard heparin anticoagulation was contraindicated due to HIT.

Findings:

  • A combined endovascular approach involving catheter-directed pharmacologic thrombolysis and balloon venoplasty was employed.
  • Argatroban, a direct thrombin inhibitor, was used for anticoagulation, serving as a safe alternative to heparin.
  • This multimodality treatment successfully resolved the venous occlusion and preserved limb viability.

Implications:

  • This case demonstrates the efficacy of a combined endovascular strategy for PCD in patients with HIT.
  • Pharmacologic thrombolysis and mechanical interventions offer a viable treatment option when heparin is contraindicated.
  • Successful limb salvage in complex DVT cases highlights the importance of tailored anticoagulation and advanced endovascular techniques.

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