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Simultaneous arterial and venous ultrasound-assisted thrombolysis for phlegmasia cerulea dolens

Imtiaz R Khan1, James G Reeves, Paul J Riesenman

  • 1Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Emory University, Atlanta, GA, USA.

Annals of Vascular Surgery
|April 26, 2011
PubMed

Insights

Phlegmasia cerulea dolens, a rare condition causing severe venous outflow obstruction, can lead to limb loss. This case highlights successful treatment with combined intra-arterial and intravenous thrombolysis.

Area of Science:

  • Vascular Surgery
  • Interventional Radiology
  • Thrombosis Management

Background:

  • Phlegmasia cerulea dolens (PCD) is a rare, severe form of deep vein thrombosis (DVT).
  • PCD causes extensive venous occlusion, leading to limb edema, cyanosis, pain, and high rates of amputation and mortality.
  • Current treatment consensus for PCD remains limited, with ongoing evolution towards less invasive therapies.

Observation:

  • A patient presented with phlegmasia cerulea dolens and concurrent arterial and venous thrombosis in the affected extremity.
  • The clinical presentation included significant edema, cyanosis, and pain, indicative of compromised venous outflow.

Findings:

  • Successful treatment of phlegmasia cerulea dolens with concomitant arterial and venous thrombosis was achieved.
  • The therapeutic approach involved combined ultrasound-assisted intra-arterial and intravenous catheter-directed thrombolysis.

Implications:

  • This case demonstrates the efficacy of combined catheter-directed thrombolysis for complex PCD involving arterial thrombosis.
  • The findings suggest a potential minimally invasive treatment option for severe DVT with arterial compromise.
  • Further research into combined thrombolysis techniques may refine treatment strategies for limb-threatening venous thromboembolic events.

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