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Successful treatment of phlegmasia cerulea dolens with combination surgical and catheter-assisted thrombectomy

Barbu Gociman1, Mario Castillo-Sang, Mohmmed Margni

  • 1Department of Surgery, The University of Toledo Health Science Center, Toledo, OH 43614, USA. bgociman@utoledo.edu

Vascular
|May 12, 2009
PubMed

Insights

Phlegmasia cerulea dolens, a rare condition from venous occlusion, requires prompt treatment to prevent limb loss. This case highlights successful treatment using catheter-assisted thrombectomy for extensive venous thrombosis.

Area of Science:

  • Vascular Surgery
  • Interventional Radiology
  • Emergency Medicine

Background:

  • Phlegmasia cerulea dolens (PCD) is a rare, severe condition caused by extensive venous thrombosis leading to arterial compromise.
  • Prompt diagnosis and treatment are critical to prevent limb ischemia, gangrene, and mortality.
  • Standard treatments include thrombolysis or surgical thrombectomy, especially when anticoagulation is contraindicated.

Observation:

  • A 47-year-old male developed PCD after severe trauma and placement of an inferior vena cava filter.
  • Initial attempts at balloon thrombectomy of the iliac veins and inferior vena cava were unsuccessful.
  • The patient presented with caval thrombosis and progression to phlegmasia cerulea dolens.

Findings:

  • Successful treatment was achieved with a combination of surgical thrombectomy of lower extremity veins and catheter-assisted thrombectomy of the iliac veins and inferior vena cava.
  • Catheter-assisted thrombectomy avoided the need for laparotomy and direct caval thrombus evacuation.
  • The patient experienced full symptom resolution with no residual venous clot on follow-up ultrasound.

Implications:

  • Catheter-assisted thrombectomy offers a less invasive and effective alternative for treating PCD with impending gangrene.
  • This approach can be crucial in complex cases where standard methods fail or are contraindicated.
  • Timely and effective intervention can significantly improve patient outcomes, avoiding amputation and reducing mortality.

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