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Delayed onset phlegmasia cerulea dolens post-SARS-CoV-2 infection treated with minimally invasive clot retrieval

Michael Carey1, Osaid Alser2, Jessica Leist2

  • 1School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX.

Journal of Vascular Surgery Cases and Innovative Techniques
|December 26, 2022
PubMed

Insights

Coronavirus disease 2019 increases the risk of venous thromboembolism. A rare case of phlegmasia cerulean dolens, a severe deep vein thrombosis, occurred 8 weeks after COVID-19 infection, leading to acute limb ischemia.

Area of Science:

  • Vascular Surgery
  • Infectious Diseases
  • Critical Care Medicine

Background:

  • Coronavirus disease 2019 (COVID-19) is linked to an increased risk of venous thromboembolic events.
  • Phlegmasia cerulean dolens is a severe manifestation of deep vein thrombosis (DVT), characterized by extensive venous obstruction and potential for acute limb ischemia.

Observation:

  • A 58-year-old woman presented with delayed-onset phlegmasia cerulean dolens in her left lower extremity, 8 weeks post-COVID-19 infection.
  • The condition progressed to compartment syndrome and acute limb ischemia due to external compression from severe edema.

Findings:

  • The patient underwent emergent minimally invasive percutaneous mechanical thrombectomy.
  • A four-compartment fasciotomy was performed to relieve pressure and restore arterial perfusion.

Implications:

  • This case highlights a rare but severe delayed complication of COVID-19, emphasizing the need for vigilance in monitoring for thromboembolic events.
  • Prompt surgical intervention, including thrombectomy and fasciotomy, can be life-saving and limb-saving in managing phlegmasia cerulean dolens secondary to COVID-19.
  • Understanding the pathophysiology of COVID-19-associated coagulopathy is crucial for preventing and treating such severe vascular complications.

Keywords:
COVID-19Phlegmasia cerulean dolensminimally invasive percutaneous mechanical thrombectomy

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