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Management of phlegmasia cerulea dolens caused by a giant leiomyoma

Elisabeth Ekkel1, Tara Chandran1, Michael Trpkovski2

  • 1Department of Surgery, Henry Ford Macomb Hospital, Clinton Township, MI.

Journal of Vascular Surgery Cases and Innovative Techniques
|May 2, 2022
PubMed

Insights

A large uterine fibroid caused a rare, severe venous thrombosis. Treatment involved clot removal and a hysterectomy, but thrombosis recurred, requiring repeat intervention and stent placement.

Area of Science:

  • Vascular Surgery
  • Gynecologic Oncology
  • Interventional Radiology

Background:

  • Uterine leiomyomas, or fibroids, can rarely cause significant venous compression.
  • Phlegmasia cerulea dolens is a severe form of deep vein thrombosis with limb ischemia.

Observation:

  • A young woman presented with phlegmasia cerulea dolens due to a large uterine leiomyoma compressing iliac veins.
  • Initial treatment included catheter-directed thrombolysis and mechanical thrombectomy.

Findings:

  • Recurrent iliac vein thrombosis occurred post-hysterectomy despite an inferior vena cava filter.
  • Repeat mechanical thrombectomy with wall stent placement successfully resolved the recurrent thrombosis.

Implications:

  • This case highlights the complex management of venous thrombosis secondary to uterine leiomyomas.
  • Multidisciplinary intervention is crucial for successful outcomes in such rare presentations.
  • Endovascular techniques are vital for managing recurrent venous thromboembolism after surgical intervention.

Keywords:
Phlegmasia cerulea dolensThrombectomyUterine leiomyoma

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