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

Abstract

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.

Delayed onset phlegmasia cerulea dolens post-SARS-CoV-2 infection treated with minimally invasive clot retrieval technology

“…Fasciotomy is generally deemed unnecessary in the setting of PCD, as the primary issue is a blockage of the venous outflow and recanalization of the deep venous system alone often resolves the condition. 26 However, the patient we present had signs of arterial ischemia and compartment syndrome in the setting of PCD, such as a history of acute onset left lower extremity pain, numbness, and coldness, as well as absent pedal pulses when she was normotensive (104/76 mmHg) and palpable pulses in the contralateral foot upon her ED presentation. Additionally, the patient’s initial CT scan showed edematous muscle, and her arteriogram showed tapered stenosis of the left popliteal artery, commonly seen in external compression of the artery secondary to edematous muscle in compartment syndrome.…”

Analysis and Literature Review of Deep Vein Thrombosis Related Phlegmasia Cerulea Dolens Diagnosis in Critically Patients

“…Mühlberger D et al published a paper on 17 patients with PCD treated with multimodal venous recanalization in 2020, concluding that early recanalization and restoration of venous outflow are necessary for success. Highly urgent surgical embolization combined with multimodal endovenous strategies may be a viable treatment option [9]. In conclusion, the treatment strategy for femoral bruising varies from individual to individual.…”

Stellenwert der operativen multimodalen venösen Thrombektomie bei der Behandlung der akuten iliofemoralen Thrombose

“…Die Indikation zur multimodalen operativen Thrombektomie ist stets gegeben bei der insgesamt seltenen Phlegmasia coerulea dolens zur Abwendung der drohenden Amputation [9]. Ansonsten beschränkt sich die Indikation auf jüngere Menschen mit komplexer Thrombose und Beteiligung der Beckenetage.…”