Surgery for the Venous Disaster - Phlegmasia Cerulea Dolens
DOI:
https://doi.org/10.1532/hsf.2461Abstract
Phlegmasia cerulea dolens is an acute fulminating form of extensive venous thrombosis. Limb loss, post-thrombotic syndrome and life-threatening conditions can occur without appropriate management.
Treatment methods vary; there presently is no consensus on the best form of treatment. Endovascular procedures have been a good option for treating deep vein thrombosis, yet they may be insufficient for patients suffering from phlegmasia cerulea dolens. Venous thrombectomy with the guidance of venography quickly relieves symptoms, hardly causes complications, yields optimal mid-term results, and can be a justifiable treatment for phlegmasia cerulea dolens.
References
Amin VB, Lookstein RA. 2014. Catheter-directed interventions for acute iliocaval deep vein thrombosis. Tech Vasc Interv Radiol 17(2):96-102.
Casey ET, Murad MH, Zumaeta GM, et al. 2012. Treatment of acute iliofemoral deep vein thrombosis. J Vasc Surg 55(5):1463-1473.
Chinsakchai K, Ten Duis K, Moll FL, de Borst GJ. 2011. Trends in management of phlegmasia cerulea dolens. Vasc Endovascular Surg 45(1):5-14.8.
Comerota AJ. 2012. The current role of operative venous thrombectomy in deep vein thrombosis. Semin Vasc Surg 25(1):2-12.
Goyal VD, Gupta B, Choudhary U, Maheshwari P, Iyer D. 2013. Venous thrombectomy in cases of acute deep vein thrombosis presenting as acute limb ischemia (Phlegmasia Cerulea Dolens): report of 2 cases and review of literature. Indian J Thorac Cardiovasc Surg 30(1):36-9.
Igari K, Kudo T, Toyofuku T, Jibiki M, Inoue Y. 2014. Surgical thrombectomy and simultaneous stenting for deep venous thrombosis caused by iliac vein compression syndrome (May-Thurner syndrome). Ann Thorac Cardiovasc Surg 20(6):995-1000.
Ikegami T, Kuriyama A, Matsukubo S. 2016. Phlegmasia cerulea dolens. QJM. doi: 10.1093/qjmed/hcw016.
Jaff MR, McMurtry MS, Archer SL, et al. 2011. Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: a scientific statement from the American Heart Association. Circulation 123(16):1788-1830.
Kalagher SD, Kane DD. 2015. Phlegmasia cerulea dolens: before and after lysis. Intern Emerg Med 10(1):103-104.
Klok FA, Huisman MV. 2013. Seeking optimal treatment for phlegmasia cerulea dolens. Thromb Res 131(4):372-3.
Lansing AM, Davis WM. 1968. Five-year follow-up study of iliofemoral venous thrombectomy. Ann Surg 168(4):620-628.
Laohapensang K, Hanpipat S, Aworn S, Orrapin S. 2013. Surgical venous thrombectomy for phlegmasia cerulea dolens and venous gangrene of the lower extremities. J Med Assoc Thai 96(11):1463-1469. PMID: 24428096.
Meissner MH. 2012. Rationale and indications for aggressive early thrombus removal. Phlebology 27 Suppl 1:78-84.
Mewissen MW, Seabrook GR, Meissner MH, Cynamon J, Labropoulos N, Haughton SH. 1999. Catheter-directed Thrombolysis for Lower Extremity Deep Venous Thrombosis: Report of a National Multicenter Registry. Radiology 211(1):39-49.
Mumoli N, Invernizzi C, Luschi R, Carmignani G, Camaiti A, Cei M. 2012. Phlegmasia cerulea dolens. Circulation 125(8):1056-1057.
Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FG; TASC II Working Group. 2007. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). J Vasc Surg doi: 10.1016/j.jvs.2006.12.037.
Onuoha CU. 2015. Phlegmasia Cerulea Dolens: A Rare Clinical Presentation. Am J Med 128(9):e27-28.
Patel NH, Plorde JJ, Meissner M. 1998. Catheter-directed thrombolysis in the treatment of phlegmasia cerulea dolens. Ann Vasc Surg 12(5):471-475.
Perkins JM, Magee TR, Galland RB. 1996. Phlegmasia caerulea dolens and venous gangrene. Br J Surg 83(1):19-23.
Rutherford RB, Baker JD, Ernst C, et al. 1997. Recommended standards for reports dealing with lower extremity ischemia: revised version. J Vasc Surg 26(3):517-538.
Sarwar S, Narra S, Munir A. 2009. Phlegmasia cerulea dolens. Tex Heart Inst J 36(1):76-77.
Thery C, Asseman P, Amrouni N, et al. 1990. Use of a new removable vena cava filter in order to prevent pulmonary embolism in patients submitted to thrombolysis. Eur Heart J 11(4):334-341.
Wakefield TW. 2009. Treatment algorithm for acute deep venous thrombosis:
current guidelines. In: Gloviczki P (eds) Handbook of venous disorders. Hodder Arnold, London. pp 265-76.
Warkentin TE, Elavathil LJ, Hayward CP, Johnston MA, Russett JI, Kelton JG. 1997. The pathogenesis of venous limb gangrene associated with heparin-induced thrombocytopenia. Ann Intern Med 127(9):804-812.
Weaver FA, Meacham PW, Adkins RB, Dean RH. 1988. Phlegmasia cerulea dolens: therapeutic considerations. South Med J 81(3):306-312.
Yang SS, Yun WS. Surgical Thrombectomy for Phlegmasia Cerulea Dolens.2016.Vasc Specialist Int 32(4):201-4.
Zhang X, Chen Z, Sun Y, Xu M. 2018. Surgical Thrombectomy and Simultaneous Stenting for Phlegmasia Cerulea Dolens Caused by Iliac Vein Occlusion. Ann Vasc Surg 51:239-245.
