Phlegmasia Cerulea Dolens with Compartment Syndrome

Chaochankit, Wongsakorn; Akaraborworn, Osaree

doi:10.3400/avd.cr.18-00030

Cited by 34 publications

(42 citation statements)

References 9 publications

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“…However, PCD is an extensive form of DVT with excess thrombus load. 16 Unlike most DVTs, limited 480-s use of AngioJet™ is not sufficient for most patients with PCD. Limiting time for RT can be one of the reasons for the absence of total recanalization in any of our patients in the first attempt.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of rheolytic thrombectomy in phlegmasia cerulea dolens

Saydam¹,

Şerefli²

2020

Vascular

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Objective The purpose of this study was to assess the clinical features of phlegmasia cerulea dolens and present the treatment outcomes with rheolytic thrombectomy device. Methods From January 2014 and March 2019, 329 patients were diagnosed and hospitalized for acute iliofemoral deep vein thrombosis, and among those patients, seven patients diagnosed with lower extremity phlegmasia cerulea dolens were consecutively enrolled. Diagnosis of phlegmasia cerulea dolens was initially made on clinical findings followed by imaging with Doppler ultrasound. The rheolytic thrombectomy device was used in all patients with a combination of catheter-directed thrombolysis as an adjunctive therapy to facilitate more rapid thrombus clearance except for one patient who had a contraindication to the use of tissue plasminogen activator. Results Seven patients (four men, three women; median age, 63 years, range 52–68 years) were included. One patient had a relative contradiction to thrombolysis due to history of coronary artery bypass graft surgery; all other patients underwent pharmaco-mechanical thrombectomy with power pulse mode. The upper limit of 480 s was completed in all patients, and this time was not exceeded to prevent hemolysis-related complications. Six Fr catheters were used in four (57.1%) patients, and 8 Fr catheters were used in three patients (42.9%). Mean thrombolytic infusion duration was 28 ± 6.2 h for patients who received tissue plasminogen activator. After catheter-directed thrombolysis, total radiological success was achieved in two patients, and partial radiologic success was achieved in five patients; however, in all seven patients, clinical success was achieved. The mean duration for complete regression of cyanosis was 18.9 ± 8.1 h. Although no patients required blood replacement, mean decreases in hemoglobin and hematocrit were 2.7 ± 1.37 g/dl and 6.42 ± 4.47%, respectively. Acute kidney injury developed in three patients (42.9%). One patient required continuous renal replacement therapy. No cardiac complication was observed. One (14.3%) patient died of ventilator-related pneumonia on postprocedural day 10. The median duration of intensive care unit stay and hospital stay were 72 h (min–max: 24–264 h) and six days (min–max: 5–33 days), respectively. Conclusion Rheolytic thrombectomy was less invasive and effective strategy for early stage phlegmasia cerulea dolens at creating rapid thrombus clearance to establish clinical success and facilitate more conservative management with catheter-directed thrombolysis.

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Section: Discussionmentioning

confidence: 99%

Outcomes of rheolytic thrombectomy in phlegmasia cerulea dolens

Saydam¹,

Şerefli²

2020

Vascular

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“…Most PCD patients have a large iliofemoral DVT, and some have additional involvement of the inferior vena cava (IVC) [61]. PCD is usually associated with tense swelling of the limb, pain out of proportion, and cyanosis [60,62]. In small case series and case reports, PCD has frequently led to death (40%), limb amputation (50%), and PE (22%) despite the use of anticoagulant therapy [60].…”

Section: Acute Limb Threatmentioning

confidence: 99%

Catheter-Based Therapies and Other Management Strategies for Deep Vein Thrombosis and Post-Thrombotic Syndrome

Thukral

Vedantham

2020

JCM

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Acute deep vein thrombosis (DVT) causes substantial short-term and long-term patient morbidity. Medical, lifestyle, and compressive therapies have been investigated for the prevention of pulmonary embolism (PE) and recurrence of venous thromboembolism (VTE). However, patient-centered outcomes such as resolution of presenting DVT symptoms and late occurrence of post-thrombotic syndrome (PTS) have not been prioritized to the same degree. Imaging-guided, catheter-based endovascular therapy has been used in selected patients to alleviate these sequelae, but important questions remain about their optimal use. In this article, we review the available evidence and summarize the rationale for use of catheter-based therapy in specific patient groups.

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“…The incidence of a deep vein thrombosis is about 1/1000 patients per year 1 and pulmonary embolism is one notable complication as it can cause sudden death. 2 Phlegmasia cerulea dolens (PCD) is characterized by the triad of an extreme swollen leg, cyanosis, and massive pain.…”

Section: Introductionmentioning

confidence: 99%

“…Advanced PCD is a hazardous complication of a deep vein thrombosis, 6,7 even though it is extremely rare. Due to the markedly dangerousness, it has been called “the ugly face of deep vein thrombosis.” 6 Most frequently, there exist case reports, 1,8–10 and only a few case series in single centers have been published recently. 11–13 Advanced PCD is characterized by an extreme venous obstruction based on a fulminant iliofemoral deep vein thrombosis.…”

Section: Introductionmentioning

confidence: 99%

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Multimodal approach of venous recanalization in patients with a critical limb ischemia due to phlegmasia cerulea dolens: A case series of 17 patients in a single center

et al. 2020

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Objectives Advanced phlegmasia cerulea dolens can be a hazardous complication of a deep vein thrombosis and rapid recanalization of the deep venous system is the most important factor. Method We describe the outcome of 17 patients with critical limb ischemia due to an advanced phlegmasia cerulea dolens. Venous thrombectomy was performed by a standardized operating procedure. Results Venous recanalization was successful in all patients. An additional fasciotomy was not necessary. There were five patients with an underlying malignancy and eight patients with a simultaneous pulmonary embolism. We had one amputation of a forefoot and one death within 30 days representing a 30-day mortality and an amputation rate of 6%. Conclusions Early recanalization and recovery of the venous outflow is mandatory for success. A multimodal therapeutic approach of high urgency surgical thrombectomy in combination with endovenous strategies could be a successful treatment option for advanced phlegmasia cerulea dolens.

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Phlegmasia Cerulea Dolens with Compartment Syndrome

Cited by 34 publications

References 9 publications

Outcomes of rheolytic thrombectomy in phlegmasia cerulea dolens

Outcomes of rheolytic thrombectomy in phlegmasia cerulea dolens

Catheter-Based Therapies and Other Management Strategies for Deep Vein Thrombosis and Post-Thrombotic Syndrome

Multimodal approach of venous recanalization in patients with a critical limb ischemia due to phlegmasia cerulea dolens: A case series of 17 patients in a single center

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