Surgery for the Venous Disaster - Phlegmasia Cerulea Dolens
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.
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.
How to Cite
Author Disclosure & Copyright Transfer Agreement
In order to publish the original work of another person(s), The Heart Surgery Forum® must receive an acknowledgment of the Author Agreement and Copyright Transfer Statement transferring to Forum Multimedia Publishing, L.L.C., a subsidiary of Carden Jennings Publishing Co., Ltd. the exclusive rights to print and distribute the author(s) work in all media forms. Failure to check Copyright Transfer agreement box below will delay publication of the manuscript.
A current form follows:
The author(s) hereby transfer(s), assign(s), or otherwise convey(s) all copyright ownership of the manuscript submitted to Forum Multimedia Publishing, LLC (Publisher). The copyright transfer covers the exclusive rights to reproduce and distribute the article and the material contained therein throughout the world in all languages and in all media of expression now known or later developed, including but not limited to reprints, photographic reproduction, microfilm, electronic data processing (including programming, storage, and transmission to other electronic data record(s), or any other reproductions of similar nature), and translations.
However, Publisher grants back to the author(s) the following:
- The right to make and distribute copies of all or part of this work for use of the author(s) in teaching;
- The right to use, after publication in The Heart Surgery Forum, all or part of the material from this work in a book by the author(s), or in a collection of work by the author(s);
- The royalty-free right to make copies of this work for internal distribution within the institution/company that employs the author(s) subject to the provisions below for a work-made-for-hire;
- The right to use figures and tables from this work, and up to 250 words of text, for any purpose;
- The right to make oral presentations of material from this work.
Publisher reserves the right to grant or refuse permission to third parties to republish all or part of the article or translations thereof. To republish, such third parties must obtain written permission from the Publisher. (This is in accordance with the Copyright Statute, United States Code, Title 17. Exception: If all authors were bona fide officers or employees of the U.S. Government at the time the paper was prepared, the work is a “work of the US Government” (prepared by an officer or employee of the US Government as part of official duties), and therefore is not subject to US copyright; such exception should be indicated on signature lines. If this work was prepared under US Government contract or grant, the US Government may reproduce, royalty-free, all or portions of this work and may authorize others to do so, for official US Government purposes only, if the US Government contract or grant so requires.
I have participated in the conception and design of this work and in the writing of the manuscript and take public responsibility for it. Neither this manuscript nor one with substantially similar content under my authorship has been published, has been submitted for publication elsewhere, or will be submitted for publication elsewhere while under consideration by The Heart Surgery Forum, except as described in an attachment. I have reviewed this manuscript (original version) and approve its submission. If I am listed above as corresponding author, I will provide all authors with information regarding this manuscript and will obtain their approval before submitting any revision. I attest to the validity, accuracy, and legitimacy of the content of the manuscript and understand that Publisher assumes no responsibility for the validity, accuracy, and legitimacy of its content. I warrant that this manuscript is original with me and that I have full power to make this Agreement. I warrant that it contains no matter that is libelous or otherwise unlawful or that invades individual privacy or infringes any copyright or other proprietary right. I agree to indemnify and hold Publisher harmless of and from any claim made against Publisher that relates to or arises out of the publication of the manuscript and agree that this indemnification shall include payment of all costs and expenses relating to the defense of any such claim, including all reasonable attorney’s fees.
I warrant that I have no financial interest in the drugs, devices, or procedures described in the manuscript (except as disclosed in the attached statement).
I state that the institutional Human Subjects Committee and/or the Ethics Committee approved the clinical protocol reported in this manuscript for the use of experimental techniques, drugs, or devices in human subjects and appropriate informed consent documents were utilized.
Furthermore, I state that any and all animals used for experimental purposes received humane care in USDA registered facilities in compliance with the “Principles of Laboratory Animal Care” formulated by the National Society for Medical Research and the “Guide for the Care and Use of Laboratory Animals” prepared by the Institute of Laboratory Animal Resources and published by the National Institutes of Health (NIH Publication No. 85-23, revised 1985).