Iliac Vein Stenting and Thrombectomy Result in Limb Salvage in Phlegmasia Caerulea Dolens as a Result of Heavy Fibroid Burden.

Phlegmasia cerulea dolens is a devastating sequelae of propagating deep vein thrombosis causing total venous outflow obstruction of an extremity. It is characterized by significant pain, edema, cyanosis, and critical limb ischemia and may progress toward venous gangrene. Morbidity and mortality rates associated with this phenomenon are high. Treatment options are limited and consist of early and aggressive therapeutic anticoagulation and fluid resuscitation, followed by thrombectomy or thrombolysis if the patient fails to respond clinically in 6-12 hours.

Upper extremity phlegmasia cerulea dolens complicating supra vena cava embolism in a cervical cancer patient: case report.

Phlegmasia cerulea dolens (PCD) is a rare yet severe complication of deep vein thrombosis (DVT), characterized by a high amputation rate and mortality. Early diagnosis and treatment are crucial in managing this condition. PCD predominantly affects the lower extremities rather than the upper extremities. We herein present a rare upper extremity PCD case accompanied with supra vena cava and pulmonary embolism in a cervical cancer patient, who presented to our institution with severe pain, edema and irreversible venous gangrene of right upper limb with no response to anticoagulation therapy. Emergency fasciotomy and amputation were performed due to the progressed venous gangrene, however, the patient developed severe infection and coagulation disorders, gastrointestinal bleeding and disseminated intravascular coagulation after the surgery. Despite medical interventions, her family chose to withdraw treatment and the patient died in ICU at the fourth day following emergency surgery.

Phlegmasia cerulea dolens of the upper extremity treated with anticoagulation and leech therapy.

Phlegmasia cerulea dolens is a serious manifestation of venous thrombosis that has a high risk of morbidity and mortality. If not promptly treated on presentation, progressive extremity ischemia and potential gangrene can lead to emergency amputation of the affected limb. Most commonly, the lower extremities are affected, and reports of upper extremity phlegmasia are scarce. We report the successful treatment of phlegmasia cerulea dolens of the distal upper extremity using leech therapy combined with anticoagulation.

Successful Intravascular Ultrasound-Guided Thrombus Removal and Angioplasty for Phlegmasia Cerulea Dolens in a Young Male With a History of Multiple Lower Extremity Deep Vein Thrombosis.

Phlegmasia cerulea dolens is a rare and severe form of deep venous thrombosis (DVT), characterized by an extensive thrombus burden and compromised venous outflow. We present the case of a 28-year-old male with a history of bilateral lower extremity DVTs and multiple venous stents who presented with acute-onset pain and swelling in the left lower extremity. Diagnostic imaging confirmed an acute DVT extending throughout the left lower extremity, including the external iliac vein. Given the diagnosis of phlegmasia cerulea dolens, a multidisciplinary approach involving interventional cardiology, orthopedic surgery, and vascular surgery was adopted. Intravascular ultrasound (IVUS)-guided thrombus removal and angioplasty were performed to restore venous outflow and improve limb perfusion. The procedure successfully removed a significant amount of thrombus and improved flow throughout the venous system. The patient exhibited an excellent clinical response, with pain resolution and improved perfusion. This case highlights the challenges and effectiveness of a combined intervention in managing complex phlegmasia cerulea dolens cases with previous venous stents.

Staged Treatment of Phlegmasia Cerulea Dolens in a Patient with Iliac Vein Compression Syndrome and Deep Vein Thrombosis: A Case Report.

Iliac vein compression syndrome (IVCS) is defined as extrinsic compression of the left common iliac vein (LCIV) between the overlying right common iliac artery and the lumbar vertebra. The most severe complication is phlegmasia cerulea dolens (PCD), a medical emergency that requires quick intervention to prevent irreversible limb ischemia. This article reports the case of a patient with PCD as the first manifestation of IVCS. The treatment included embolectomy and fasciotomy. Bilateral femoral iliac axis phlebography and cavography were performed 48 hours after the procedure. The IVCS was identified, and balloon predilatation of the lesions followed by implantation of self-expanding stents from the confluence of the LCIV with the inferior vena cava to the middle portion of the left external iliac vein was performed. Postprocedure phlebography demonstrated satisfactory final results, and a 12-month follow-up image showed patent stents and minimal intimal hyperplasia.

COVID-19-Induced Phlegmasia Cerulea Dolens.

A 44-year-old male with a history of deep venous thrombosis (DVT) and pulmonary embolism (PE) with the inferior vena cava (IVC) filter in place and peripheral vascular disease (PVD) status post lower extremity vascular stenting presented from a COVID-19 rehabilitation center with bilateral phlegmasia cerulea dolens and no palpable popliteal or dorsalis pedis pulses, at risk for venous gangrene and loss of limbs. The patient was anticoagulated and taken emergently to the operating room for vascular surgery where thrombolysis with alteplase and mechanical thrombectomy were performed. Bilateral thrombolysis infusion catheters were placed for two days. The patient had a return of arterial signals in the feet and decreasing clot burden. The patient is expected to make a full recovery.

Phlegmasia cerulea dolens causing compartment syndrome.

BACKGROUND: Phlegmasia cerulea dolens (PCD) is a rare condition characterized by a severely swollen, cyanotic, blue extremity due to a large proximal (iliofemoral) deep venous thrombosis extending into the collateral veins. Mortality in PCD ranges 20-40%. Due to severely compromised venous drainage, compartment pressures can rapidly increase 16-fold within 6 h, but rarely result in arterial compromise. CASE REPORT: We present a case of a middle-aged woman with no prior history of deep venous thrombosis, with a blue swollen left leg in intractable severe pain unresponsive to 3 doses of hydromorphone. Her pain was successfully alleviated with IV Lidocaine. Patient was found to have phlegmasia cerulea dolens resulting in compartment syndrome of her left leg. Although the patient initially had no motor function, after catheter-directed thrombolysis and emergent thrombectomy, she regained her motor function and made a full recovery. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Phlegmasia cerulea dolens complicated by severe compartment syndrome is a rare entity. Prompt recognition and treatment are necessary to prevent irreversible limb ischemia and associated morbidity and mortality. IV Lidocaine may be considered as an option for analgesia for such patients.

Management of phlegmasia cerulea dolens caused by a giant leiomyoma.

In the present report, we describe the case of a young woman with a large uterine leiomyoma causing phlegmasia cerulea dolens with thrombosis of the left common and left external iliac veins. She underwent tissue plasminogen activator catheter thrombolysis and mechanical thrombectomy to temporize the condition until she could be evaluated by a gynecologic oncologist to remove the cause of the venous obstruction. Before the hysterectomy, a suprarenal inferior vena cava filter was placed. However, <12 hours after the hysterectomy, she developed recurrent thrombosis involving the left common and external iliac veins. She underwent repeat mechanical thrombectomy with wall stent placement in the left common iliac vein with resolution of her symptoms.

Blue Leg: Phlegmasia Cerulea Dolens Secondary to May Thurner Syndrome.

Phlegmasia cerulea dolens (PCD) can present as leg pain accompanied by bluish discoloration. It is a limb-threatening emergency that needs to be promptly addressed with anticoagulation with consideration of thrombolytics. We present a case of PCD in an 83-year-old female without obvious risk factor for thrombosis, found to have May Thurner Syndrome (MTS) requiring a chemical and mechanical approach to prevent catastrophic outcomes.

Phlegmasia Cerulea Dolens Secondary to COVID-19 and May-Thurner Syndrome: A Case Report.

Coronavirus disease 2019 (COVID-19) is associated with significant thromboembolic risk. Extensive deep vein thrombosis can infrequently progress to phlegmasia cerulea dolens that carries high morbidity and mortality rates. We report a case of a middle-aged male presenting with phlegmasia cerulea dolens in the context of COVID-19 and underlying May-Thurner syndrome, associated with transiently positive antiphospholipid antibodies.

Upper-Extremity Phlegmasia Cerulea Dolens With Compartment Syndrome in Coronavirus Disease 2019 Sepsis.

A 54-year-old woman with leukemia presented with coronavirus disease 2019 and a right upper-extremity indwelling peripherally inserted central catheter line for chemotherapy administration. On hospital admission day 9, she developed acute right upper-extremity edema and pain. Ultrasound demonstrated complete superficial and deep venous thrombosis up to the proximal subclavian vein. Her examination result was consistent with acute phlegmasia cerulea dolens and compartment syndrome, but respiratory instability prevented transfer and vascular surgery intervention. Instead, we performed bedside fasciotomies and administered therapeutic heparin, and the limb was salvaged. This case underscores the potential for successful limb salvage in patients with phlegmasia in the setting of coronavirus disease 2019 via compartment release and therapeutic anticoagulation.

Direct Iliac Vein Stenting in Phlegmasia Cerulea Dolens Caused by May-Thurner Syndrome.

Phlegmasia cerulea dolens (PCD) is an uncommon but potentially limb-threatening complication of acute deep vein thrombosis. A 56-year-old male presented with PCD. Color Doppler ultrasonography revealed extensive thrombosis of the left superficial and common femoral and external and common iliac veins. After an unsuccessful iliofemoral thrombectomy, contrast-enhanced computed tomography revealed iliofemoral deep vein thrombosis due to May-Thurner syndrome (MTS). After the deployment of an inferior vena cava filter, the thrombotic occlusion was traversed with a guidewire and direct stenting was performed to achieve immediate recanalization. The patient was discharged two days after the procedure, demonstrating significant clinical improvement. MTS is a rare cause of PCD. Direct iliac vein stenting may be a safe and effective alternative treatment for rapid recanalization if percutaneous mechanical thrombectomy devices are unavailable.

Phlegmasia Cerulea Dolens, a Deadly Complication of Deep Vein Thrombosis: Case Report and Review of Literature.

Phlegmasia cerulea dolens (PCD) is a rare limb and life-threatening condition caused by extensive deep vein thrombosis of the extremities, and it is classically associated with extensive oedema, severe pain, and skin mottling, which may lead to compartment syndrome, venous gangrene, and even death. A 40-year-old male, with a background history of right femoral vein thrombosis, cardiomyopathy, with an ejection fraction of only 10%, presented with three days history of progressive swelling, pain, and discolouration of the right lower limb. He was treated with therapeutic low molecular weight heparin along with supportive care with intravenous fluids and pain relief. In view of his poor ejection fraction, he was treated non-operatively with supportive care. The patient succumbed after three months of presentation. PCD is a rare vascular emergency condition that if not recognized early and treated aggressively may lead to higher morbidity and mortality.

Half-Dose Anticoagulation for Venous Thromboembolism and Phlegmasia Cerulea Dolens in a Patient With Recurrent Subdural Hematoma.

Anticoagulation for venous thromboembolism (VTE) in patients with recurrent subdural hematoma (SDH) is challenging. It becomes even more challenging when the patient develops phlegmasia cerulea dolens (PCD). We present a 66-year-old female with a recent history of recurrent SDH who received half-dose heparin therapy for VTE and PCD. The patient had improvement of dyspnea and resolution of PCD after two days of treatment. She was discharged with half-dose enoxaparin. At her one-month follow-up, there was no evidence of new SDH or progression of VTE. Half-dose anticoagulation therapy should be considered in patients with recurrent SDH when anticoagulation is inevitable.

Hypercoagulability Due to COVID-19 Leading to Impending Phlegmasia Cerulea Dolens and Sub-Massive Bilateral Pulmonary Embolism.

This is a case report of a 47-year-old male with a history of hypertension and pre-diabetes who presented to the emergency department with dyspnea, progressive unilateral leg swelling and pain. The patient tested positive for coronavirus disease 2019 (COVID-19) infection about a week earlier. The patient was found to have an extensive clot burden of his lower extremity veins, both deep and superficial, which extended to his inferior vena cava (IVC). Based on the patient's clinical exam and ultrasound findings, the patient was diagnosed with impending phlegmasia cerulea dolens. Due to his renal failure, the patient was taken for a ventilation/perfusion (V/Q) scan which found widespread V/Q mismatch highly suggestive of pulmonary embolism. Interventional radiology took the patient for lower extremity venogram, catheter-directed alteplase administration, and IVC filter placement. The patient was admitted to the intensive care unit (ICU) for further management and had a stable recovery.

Phlegmasia Cerulea Dolens: A New Perspective on Management.

This is a case of phlegmasia cerulea dolens (PCD) with unexpected but complete resolution of symptoms with short-term administration of heparin products, despite falling into category IIb according to the Rutherford limb ischemia scale, which regularly requires aggressive surgical intervention. We present a case of a 58-year-old Hispanic female with a past medical history of gastritis who arrived at the emergency room (ER) with acute onset severe pain on the left leg associated with discoloration of the leg. The patient was quickly diagnosed with PCD affecting the left lower extremity, which quickly resolved after administration of heparin infusion for one hour, despite the degree of limb ischemia. There is no consensus for the treatment of this condition. The most interesting feature of this case is the prompt resolution of symptoms with short-term administration of anticoagulation with total resolution without the need for thrombolysis or thrombectomy. This may suggest that prompt pharmacologic treatment in patients eligible for anticoagulation may successfully restore venous flow negating the need for further intervention.

Lacunar cerebral infarction following endovascular interventions for phlegmasia cerulea dolens.

Phlegmasia cerulea dolens is a rare presentation of deep venous thrombus treated with catheter directed thrombolysis and pharmacomechanical thrombectomy. This is the case of a 78-year-old woman who underwent catheter directed thrombolysis to treat phlegmasia cerulea dolens and subsequently developed left-sided hemiplegia and expressive aphasia in the setting of an international normalized ratio of 2.0. Further imaging revealed a lacunar infarct in the right thalamus with a middle cerebral artery distribution. Further workup revealed a patent foramen ovale. We highlight the unexpected enigmatic consequence from multimodal endovascular intervention, the consequence of long-term inferior vena cava filters.

Phlegmasia Cerulea Dolens: a sudden unexpected death with hypothesis of medical malpractice.

ABSTRACT: Phlegmasia Cerulea Dolens (PCD) is a severe and rare form of venous thrombosis of the lower extremities, caused by a subtotal or complete occlusion of venous outflow by a thrombus. PCD should be considered a real medical emergency; complications include necrosis and gangrene of the affected limb, amputation, massive pulmonary embolism and, in extreme cases, the death of the patient. Case Report. A 63-years-old man was admitted to the Emergency room with localized pain on the right calf, hyperthermia, cold sweating and vomiting episodes. Five days prior he developed flu-like symptoms, joint pain and cold sensation unresponsive to treatment. Ultrasound examination showed a deep venous thrombosis of the lower right limb with partial occlusion of common iliac and femoral veins. The patient was treated with low molecular weight heparin given twice daily. He began to develop severe hypotension and metabolic acidosis, with tachycardia and atrial fibrillation. Despite the treatment, there was no improvement and he developed severe sinus node dysfunction. He failed to respond to all resuscitative efforts and died. Family members complained Authority, assuming it was a medical error. The clinical-forensic investigation is essential to determine the causes and manner of death and to assess medical responsibility and liability.

[Phlegmasia cerulea dolens. Treatment with systemic fibrinolysis]. / Flegmasía cerulea dolens. Tratamiento con fibrinolisis sistémica.

Phlegmasia cerulea dolens (FCD) is a rare complication of deep vein thrombosis. Its cause is unknown. The main predisposing factors for the disease are neoformative processes, hypercoagulable states, congestive heart failure, pregnancy, prolonged immobilization, and surgeries on the affected limb. FCD is characterized by massive edema, severe pain, and cyanosis. The diagnosis is clinical. It is associated in most cases with pulmonary embolism and can lead to loss of the compromised limb if not treated in time. So far there is no consensus on its treatment. In clinical practice the use of anticoagulation with heparin, local thrombolysis, systemic fibrinolysis, surgical thrombectomy, fasciotomy, and inferior vena cava filter are described. In irreversible cases amputation is required. We present the case of a patient with FCD, the treatment performed and the evolution.

La flegmasia cerulea dolens es una complicación rara y poco frecuente de la trombosis venos a profunda. Los principales factores predisponentes son los procesos neoformativos, estados de hipercoagulabilidad, insuficiencia cardíaca congestiva, embarazo, inmovilización prolongada y cirugías. Se caracteriza por edema masivo, dolor intenso y cianosis. Sin tratamiento evoluciona con isquemia, necrosis y amputación del miembro comprometido. No existe consenso en su tratamiento, pero éste debe ser rápido, multidisciplinario y agresivo. La anticoagulación con heparina, la fibrinólisis sistémica, la trombectomía percutánea con fibrinólisis local, la trombectomía quirúrgica, la fasciotomía, la colocación de filtro de vena cava inferior y la amputación son algunos de los tratamientos propuestos.