PERCUTANEOUS MECHANICAL THROMBECTOMY IN PHLEGMASIA CERULEA DOLENS: CASE REPORT AND LITERATURE REVIEW

Authors

  • André Vinha Orthopaedics and Traumatology Department – Cova da Beira University Hospital Center, Covilhã, Portugal https://orcid.org/0000-0002-9606-9568
  • Joana Pimenta General Surgery Department – Baixo Alentejo Local Health Unit, Beja, Portugal
  • João Vasconcelos Vascular Surgery Department – Tâmega e Sousa Hospital Center, Penafiel, Portugal
  • Miguel Maia Vascular Surgery Department – Tâmega e Sousa Hospital Center, Penafiel, Portugal
  • José Vidoedo Vascular Surgery Department – Tâmega e Sousa Hospital Center, Penafiel, Portugal
  • João Almeida Pinto Vascular Surgery Department – Tâmega e Sousa Hospital Center, Penafiel, Portugal

DOI:

https://doi.org/10.48729/pjctvs.227

Keywords:

Phlegmasia, deep venous thrombosis, compartment syndrome

Abstract

Introduction: Phlegmasia cerulea dolens is a potentially life-threatening complication of deep venous thrombosis, causing marked swelling and sudden severe pain in the limb, associated with cyanosis, edema and compartment syndrome that together compromise arterial supply. There is no consensus on its treatment.

Case Report: A 36-year-old woman, with a history of cosmetic surgery 8 days before admission (abdominal liposuction), was admitted to the emergency department with edema, cyanosis, severe pain, decreased temperature and tenderness of the left lower limb. At physical exam, no distal pulses on the left lower limb were found. Angio-CT was performed, showing occlusion of left femoral vein, external and common iliac veins.

The patient started treatment with enoxaparin (80 mg, subcutaneous, bid) and percutaneous mechanical thrombectomy (PMT) of the left iliac vein sector was performed, followed by balloon angioplasty and stenting of the left iliac vein sector. It was also deployed a temporary filter in the inferior vena cava. Thrombophilic workup was negative.

The patient presented thorough clinical remission after the procedure (Villalta score 0). Two years after surgery, the patient is asymptomatic, and the Doppler ultrasound is unremarkable concerning morphologic changes throughout the left iliac vein sector.

Conclusion: The treatment of phlegmasia cerulea dolens is challenging due to its severity and poor prognosis. Minimally invasive procedures, such as PMT can be an alternative to open surgery. It can also avoid the use of thrombolytics in patients with relative / absolute contraindications to its use.

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References

Gregory YH Lip, Russell D Hull (2019, december 14). Overview of the treatment of lower extremity deep vein thrombosis (DVT). Retrieved from https://www.uptodate.com/contents/overview-of-the-treatment-of-lower-extremity-deep-vein-thrombosis-dvt?search=phlegmasia%20 cerulea%20dolens&source=search_result&selectedTitle=1~10&usage_type=default&display _rank=1

Wongsakorn Chaochankit, et al. Phlegmasia Cerulea Dolens with Compartment Syndrome. Ann Vasc Dis. Vol. 11, No. 3; 2018; pp 355–357

Khamin Chinsakchai, et al. Trends in Management of Phlegmasia Cerulea Dolens. Vascular and Endovascular Surgery. 45(1) 2011; 5-14.

Leslie J. Padrnos, David Garcia. May-Thurner syndrome and thrombosis: A systematic review of antithrombotic use after endovascular stent placement. Res Pract Thromb Haemost. 2019;3:70–78.

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Published

04-01-2022

How to Cite

1.
Vinha A, Pimenta J, Vasconcelos J, Maia M, Vidoedo J, Almeida Pinto J. PERCUTANEOUS MECHANICAL THROMBECTOMY IN PHLEGMASIA CERULEA DOLENS: CASE REPORT AND LITERATURE REVIEW. Rev Port Cir Cardiotorac Vasc [Internet]. 2022 Jan. 4 [cited 2022 Jan. 28];28(4):59-62. Available from: https://pjctvs.com/index.php/journal/article/view/227

Issue

Section

Clinical Cases