Venous Thromboembolism Secondary to Uterine Fibroids: A Case of Phlegmasia Cerulea Dolens and Review of the Literature

Brewer, Marilynn B.; Woo, Karen

doi:10.1016/j.avsg.2014.09.021

Cited by 5 publications

(6 citation statements)

References 19 publications

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“…Although an association between uterine fibroids and VTE is well-documented in the literature, few studies have considered this relationship in the context of secondary MTS from benign gynecologic etiologies. 10 , 11 , 12 , 13 , 14 , 15 , 16 Also, standardized guidelines for the long-term treatment of these patients are lacking. Suggestions have included long-term anticoagulation and gynecology referral for potential hysterectomy or myomectomy.…”

Section: Discussionmentioning

confidence: 99%

“…Though an association between uterine fibroids and VTE is well-documented in the literature, few publications consider this relationship in the context of secondary MTS from benign gynecological etiologies, and there is a lack of standardized guidelines for the long term management of these patients. [10][11][12][13][14][15][16] Suggestions include long term anticoagulation and gynecology referral for potential hysterectomy or myomectomy. 17,18 Uterine artery embolization is also an option, though this may be associated with a higher risk of fibroid recurrence than hysterectomy or myomectomy and also carries a risk of the post-embolization syndrome.…”

Section: J O U R N a L P R E -P R O O Fmentioning

confidence: 99%

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Venous thromboembolism in a patient with an uncommon etiology of May-Thurner syndrome

Speranza

Hager

2021

Journal of Vascular Surgery Cases, Innovations and Techniques

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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Section: Discussionmentioning

confidence: 99%

Section: J O U R N a L P R E -P R O O Fmentioning

confidence: 99%

Venous thromboembolism in a patient with an uncommon etiology of May-Thurner syndrome

Speranza

Hager

2021

Journal of Vascular Surgery Cases, Innovations and Techniques

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“…Iliac vein DVT is commonly caused by compression, particularly with pelvic masses such as large uterine fibroids. However, the progression to PCD in these cases is exceedingly rare [8].…”

Section: Discussionmentioning

confidence: 99%

“…If these measures are unsuccessful venous bypass with an arteriovenous fistula can be attempted [1]. Adjunctive measures include placement of an inferior vena cava (IVC) filter, and fasciotomy [8]. Given the high incidence of PE with PCD, IVC filter placement is an important measure to prevent further PE that may be a complication of treatment.…”

Section: Introductionmentioning

confidence: 99%

Pulseless Electrical Activity Arrest as the First Symptom of Testicular Cancer with Subsequent Phlegmasia Cerulea Dolens

Belvedere

2018

The Journal of Critical Care Medicine

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Introduction Phlegmasia cerulea dolens (PCD) is a severe, rare complication of deep vein thrombosis, which is characterised by compartment syndrome, arterial compromise, venous gangrene, and shock. Prothrombotic states are the primary risk factor for PCD, which, in most cases, is associated with pulmonary embolism and carries a high mortality. Case report A 46-year-old male presented following a pulseless electrical activity (PEA) arrest due to saddle pulmonary embolism (PE). He subsequently developed PCD and venous gangrene secondary to inferior vena cava obstruction, in the setting of a new diagnosis of testicular germ cell tumour. Discussion PEA arrest, as the initial presenting problem in malignancy, is rare. It is extreme for the first indication of cancer to be a PEA arrest from massive PE. While hypoxic brain injury from the cardiac arrest precluded intervention in this case, a surgical approach entailing en bloc resection of aortocaval metastasis, with subsequent IVC reconstruction, followed by lower limb venous thrombectomy would have been favoured as it was considered that an endovascular approach would not have been successful. Conclusion A case of a patient with phlegmasia cerulea dolens secondary to testicular cancer, who presented following PEA arrest is described.

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“…Brewer et al recommend a multifaceted approach once the diagnosis of concomitant extensive DVT has been made, involving immediate anticoagulation for infra-inguinal DVT or thrombolysis/thrombectomy for more extensive DVT. They recommended fibroid removal prior to more definitive thrombosis management to reduce DVT recurrence [36]. Fletcher et al highlighted the controversy of the use of anticoagulation in patients with menorrhagia due to the fear of worsening vaginal bleeding [37].…”

Section: Discussionmentioning

confidence: 99%

Should Prophylactic Anticoagulation Be Considered with Large Uterine Leiomyoma? A Case Series and Literature Review

Satti

Saenz

Raju

et al. 2016

Case Reports in Obstetrics and Gynecology

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Introduction. Uterine leiomyomas, also called uterine fibroids or myomas, are the most common pelvic tumors in women. They are very rarely the cause of acute complications. However, when complications occur they cause significant morbidity and mortality. Thromboembolic disease has been described as a rare complication of uterine leiomyomas. DVT is a serious illness, sometimes causing death due to acute PE. Cases. We report a case series of 3 patients with thromboembolic disease associated with uterine leiomyoma at Hurley Medical Center, Flint, Michigan, during 2015 and conduct a literature review on the topic. A literature search was conducted using Medline, PubMed, and PMC databases from 1966 to 2015. Conclusion. The uterine leiomyoma is a very rare cause of PE and only few cases have been reported. DVT secondary to uterine leiomyoma should be considered in a female presenting with abdominal mass and pelvic pressure, if there is no clear common cause for her symptoms. Thromboembolic disease secondary to large uterine leiomyoma should be treated with acute stabilization and then hysterectomy. Prophylactic anticoagulation would be beneficial for lowering the risk of VTE in patients with large uterine leiomyoma.

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Venous Thromboembolism Secondary to Uterine Fibroids: A Case of Phlegmasia Cerulea Dolens and Review of the Literature

Cited by 5 publications

References 19 publications

Venous thromboembolism in a patient with an uncommon etiology of May-Thurner syndrome

Venous thromboembolism in a patient with an uncommon etiology of May-Thurner syndrome

Pulseless Electrical Activity Arrest as the First Symptom of Testicular Cancer with Subsequent Phlegmasia Cerulea Dolens

Should Prophylactic Anticoagulation Be Considered with Large Uterine Leiomyoma? A Case Series and Literature Review

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