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PERCUTANEOUS MECHANICAL THROMBECTOMY IN PHLEGMASIA CERULEA DOLENS: CASE REPORT AND LITERATURE REVIEW
André Vinha1, Joana Pimenta2, João Vasconcelos3
1Orthopaedics and Traumatology Department - Cova da Beira University Hospital Center, Covilhã, Portugal.
Insights
Phlegmasia cerulea dolens, a severe deep venous thrombosis complication, can be effectively treated with minimally invasive percutaneous mechanical thrombectomy (PMT). This approach offers an alternative to open surgery and avoids thrombolytics in high-risk patients.
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.
Introduction:
Phlegmasia cerulea dolens is a potentially life-threatening complication of deep venous thrombosis, causing marked swelling and sudden severe pain in the limb, associated with cyanosis, edema and compartment syndrome that together compromise arterial supply. There is no consensus on its treatment.
Case Report:
A 36-year-old woman, with a history of cosmetic surgery 8 days before admission (abdominal liposuction), was admitted to the emergency department with edema, cyanosis, severe pain, decreased temperature and tenderness of the left lower limb. At physical exam, no distal pulses on the left lower limb were found. Angio-CT was performed, showing occlusion of left femoral vein, external and common iliac veins. The patient started treatment with enoxaparin (80 mg, subcutaneous, bid) and percutaneous mechanical thrombectomy (PMT) of the left iliac vein sector was performed, followed by balloon angioplasty and stenting of the left iliac vein sector. It was also deployed a temporary filter in the inferior vena cava. Thrombophilic workup was negative. The patient presented thorough clinical remission after the procedure (Villalta score 0). Two years after surgery, the patient is asymptomatic, and the Doppler ultrasound is unremarkable concerning morphologic changes throughout the left iliac vein sector.
Conclusion:
The treatment of phlegmasia cerulea dolens is challenging due to its severity and poor prognosis. Minimally invasive procedures, such as PMT can be an alternative to open surgery. It can also avoid the use of thrombolytics in patients with relative / absolute contraindications to its use.
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