PERCUTANEOUS MECHANICAL THROMBECTOMY IN PHLEGMASIA CERULEA DOLENS: CASE REPORT AND LITERATURE REVIEW.

ABSTRACT

INTRODUCTION: Phlegmasia cerulea dolens is a potentially life-threatening complication of deep venous thrombosis, causing marked swelling and sudden severe pain in the limb, associated with cyanosis, edema and compartment syndrome that together compromise arterial supply. There is no consensus on its treatment. CASE REPORT A 36-year-old woman, with a history of cosmetic surgery 8 days before admission (abdominal liposuction), was admitted to the emergency department with edema, cyanosis, severe pain, decreased temperature and tenderness of the left lower limb. At physical exam, no distal pulses on the left lower limb were found. Angio-CT was performed, showing occlusion of left femoral vein, external and common iliac veins. The patient started treatment with enoxaparin (80 mg, subcutaneous, bid) and percutaneous mechanical thrombectomy (PMT) of the left iliac vein sector was performed, followed by balloon angioplasty and stenting of the left iliac vein sector. It was also deployed a temporary filter in the inferior vena cava. Thrombophilic workup was negative. The patient presented thorough clinical remission after the procedure (Villalta score 0). Two years after surgery, the patient is asymptomatic, and the Doppler ultrasound is unremarkable concerning morphologic changes throughout the left iliac vein sector. CONCLUSION: The treatment of phlegmasia cerulea dolens is challenging due to its severity and poor prognosis. Minimally invasive procedures, such as PMT can be an alternative to open surgery. It can also avoid the use of thrombolytics in patients with relative / absolute contraindications to its use.