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Phlegmasia cerulea dolens: the role of non-operative therapy

K R Patel1, C N Paidas

  • 1Department of Surgery (12A3), Metropolitan Hospital Center, New York 10029.

Cardiovascular Surgery (London, England)
|October 1, 1993
PubMed

Insights

Non-operative therapy effectively treats phlegmasia cerulea dolens, rapidly correcting ischemia and resolving edema without complications. This approach avoids risks associated with thrombectomy and thrombolysis, preserving limbs in critically ill patients.

Area of Science:

  • Vascular Surgery
  • Critical Care Medicine

Background:

  • Phlegmasia cerulea dolens (PCD) carries a high risk of amputation and death.
  • Traditional treatments like thrombectomy and thrombolysis have significant complication rates.

Purpose of the Study:

  • To evaluate the efficacy and safety of non-operative therapy as a first-line treatment for PCD.
  • To compare outcomes of non-operative therapy with invasive procedures.

Main Methods:

  • Retrospective analysis of seven extremities in six patients with PCD treated over nine years.
  • Five extremities were managed with non-operative therapy (elevation, hydration, heparinization).
  • One patient had pre-existing gangrene, and one underwent emergency thrombectomy.

Main Results:

  • Non-operative therapy rapidly corrected ischemia in all five treated extremities.
  • Complete edema resolution occurred within 3-4 days in four patients.
  • No therapy-related complications were observed; two patients died from underlying terminal illnesses.

Conclusions:

  • Non-operative therapy is an effective and safe first-line treatment for phlegmasia cerulea dolens.
  • It successfully prevents limb loss and avoids the complications of thrombectomy and thrombolysis.
  • This approach is particularly beneficial for critically ill patients.

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