A case of phlegmesia cerulea dolens after dialysis catheter insertion

Area of Science:

• Vascular Surgery
• Nephrology
• Interventional Radiology

Background:

• Phlegmesia cerulea dolens (PCD) is a rare but severe complication of deep vein thrombosis (DVT).
• It involves massive venous thrombosis leading to arterial compromise and critical limb ischemia.
• PCD presents a significant risk of high morbidity and mortality if not promptly recognized and treated.

Observation:

• A case study involving a 71-year-old female patient with end-stage renal disease is presented.
• The patient developed PCD three days after the placement of a right femoral dialysis catheter.
• This highlights a potential iatrogenic risk factor for PCD in patients with specific comorbidities.

Findings:

• The case illustrates the critical importance of recognizing PCD as an often-overlooked cause of acute limb ischemia.
• Percutaneous catheter-directed thrombectomy is presented as an effective alternative to thrombolysis.
• This intervention is particularly suitable for patients with venous gangrene or those who fail anticoagulation therapy.

Implications:

• Early diagnosis and intervention are vital for improving outcomes in PCD patients.
• Catheter-directed thrombectomy offers a less invasive option compared to traditional surgical interventions.
• This case underscores the need for vigilance in patients with risk factors like end-stage renal disease and recent catheterization.