[Phlegmasia cerulea dolens. Treatment with systemic fibrinolysis]

Area of Science:

• Vascular Medicine
• Hematology

Background:

• Phlegmasia cerulea dolens (FCD) is a rare but severe complication of deep vein thrombosis (DVT).
• Predisposing factors include malignancy, hypercoagulable states, heart failure, pregnancy, immobilization, and surgery.
• FCD presents with massive edema, severe pain, and cyanosis, often associated with pulmonary embolism.

Observation:

• The diagnosis of FCD is primarily clinical.
• It is a critical condition that can lead to limb ischemia and loss if not promptly managed.
• Associated risks include significant morbidity and mortality due to extensive thrombosis and potential embolism.

Findings:

• There is no established consensus on the optimal treatment for FCD.
• Current management strategies involve anticoagulation, thrombolysis (local or systemic), surgical thrombectomy, fasciotomy, and inferior vena cava filters.
• Amputation may be necessary in irreversible cases.

Implications:

• This case highlights the challenges in managing FCD and the importance of timely intervention.
• Effective treatment strategies are crucial to improve patient outcomes and limb salvage.
• Further research may elucidate optimal therapeutic approaches for this rare condition.