PERCUTANEOUS MECHANICAL THROMBECTOMY IN PHLEGMASIA CERULEA DOLENS: CASE REPORT AND LITERATURE REVIEW

Area of Science:

• Vascular Surgery
• Interventional Radiology
• Thrombosis Management

Background:

• Phlegmasia cerulea dolens (PCD) is a rare, severe complication of deep venous thrombosis (DVT).
• PCD presents with limb swelling, severe pain, cyanosis, and edema, potentially leading to arterial compromise and compartment syndrome.
• Current treatment strategies for PCD lack consensus due to its high morbidity and mortality.

Observation:

• A 36-year-old woman developed PCD in her left lower limb 8 days post-abdominal liposuction.
• Physical examination revealed absent distal pulses, cyanosis, and severe edema.
• Angio-CT confirmed extensive iliofemoral venous occlusion.

Findings:

• The patient underwent successful percutaneous mechanical thrombectomy (PMT) of the left iliac vein, followed by angioplasty and stenting.
• Anticoagulation with enoxaparin was initiated, and a temporary inferior vena cava filter was placed.
• The patient achieved complete clinical remission (Villalta score 0) post-procedure and remained asymptomatic at 2-year follow-up with unremarkable Doppler ultrasound findings.

Implications:

• Minimally invasive PMT is a viable and effective treatment option for phlegmasia cerulea dolens.
• PMT can be an alternative to open surgical intervention.
• This technique may help avoid thrombolytic therapy in patients with contraindications, improving safety and outcomes.