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COVID-19-Induced Phlegmasia Cerulea Dolens
Stephanie Cohen1, Joshua Lynch1
1Emergency Medicine, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, USA.
Cureus
|February 15, 2023
Summary
A patient with a history of DVT and PE experienced severe limb swelling due to phlegmasia cerulea dolens. Emergency surgery with thrombolysis and thrombectomy successfully restored blood flow, preventing limb loss.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Thrombosis Management
Background:
- A 44-year-old male with a history of deep venous thrombosis (DVT), pulmonary embolism (PE), inferior vena cava (IVC) filter, and peripheral vascular disease (PVD) presented with critical limb ischemia.
- The patient exhibited bilateral phlegmasia cerulea dolens with absent distal pulses, indicating a high risk of venous gangrene and limb loss.
Observation:
- The patient presented from a COVID-19 rehabilitation center with acute bilateral lower extremity swelling and pulselessness.
- This critical condition placed the patient at immediate risk for limb loss due to compromised venous outflow and arterial supply.
Findings:
- Emergency vascular surgery was performed, including anticoagulation, thrombolysis with alteplase, and mechanical thrombectomy.
- Bilateral thrombolysis catheters were utilized for two days, resulting in the return of arterial signals in the feet and a significant reduction in clot burden.
Implications:
- Successful revascularization and thrombolysis averted limb loss in a patient with complex vascular history and acute limb ischemia.
- This case highlights the effectiveness of combined interventional and surgical approaches in managing severe phlegmasia cerulea dolens.
- The patient is expected to make a full recovery, underscoring the importance of timely and aggressive treatment for limb-threatening venous events.
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