Ischemic Forms of Acute Venous Thrombosis

Abstract

Venous thrombosis in an extremity, when extensive, can cause reversible tissue ischemia or frank gangrene even without arterial or capillary occlusion. Patients gradually or abruptly develop severe pain, extensive edema, and cyanosis of the extremity, nearly always in the legs. Gangrene can occur unless the venous obstruction is relieved. Such ischemic venous thrombosis can complicate surgery, trauma, childbirth, or prolonged immobility, but malignant neoplasms, either obvious or occult, are a major predisposing factor. The optimal therapy is anticoagulation and thrombectomy. Patients with venous gangrene may require amputation if extensive, deep-tissue destruction occurs. The mortality rate for ischemic venous thrombosis is about 40%, the cause of death usually being the underlying disease or pulmonary emboli.

Phlegmasia caerulea dolens of the left leg due to deep vein compression by giant mesenteric cyst: contribution of the immediate drainage of the cyst to the rapid improvement of symptoms and complete recovery

“…Women are more frequently affected, 3 mostly in the fifth and sixth decade of life, 4 especially in the left leg. 5 Associated conditions, unknown in about 10% of cases, 3 include malignancies, 3,5 abnormalities of blood coagulation, 1 previous surgery or trauma, recent delivery, 1 insertion of a caval filter, 1 intravenous drug abuse, 1 inflammatory diseases. 3 Oedema, cyanosis and severe pain represent the typical clinical features, 1 associated with arterial hypotension and sometimes severe hypovolemic shock.…”

Gangrene – but not due to diabetic vascular disease

“…There is a high level of mortality in the region of 40%, especially as there is often co‐existing pathology such as neoplasia in this patient's case. Amputations are frequently necessary although the lesions of venous gangrene are often superficial, in contrast to arterial ischaemia, which leads to deep tissue necrosis, when amputation is invariable 1, 2…”