Phlegmasia Cerulea Dolens Secondary to COVID-19 and May-Thurner Syndrome: A Case Report

Abstract

Coronavirus disease 2019 (COVID-19) is associated with significant thromboembolic risk. Extensive deep vein thrombosis can infrequently progress to phlegmasia cerulea dolens that carries high morbidity and mortality rates. We report a case of a middle-aged male presenting with phlegmasia cerulea dolens in the context of COVID-19 and underlying May-Thurner syndrome, associated with transiently positive antiphospholipid antibodies.

Post-COVID-19 Vaccine Thromboembolic Complication in the Setting of Newly Diagnosed May-Thurner Syndrome

“…MTS confers a predisposition for extensive DVT of the left lower extremity [ 1 , 2 ]. The compression of the left iliac vein leads to venous thrombosis secondary to impaired venous return owing to stasis.…”

“…The chronic pulsatile action of the artery irritates the endothelium of the vein, eventually leading to venous spur formation and, consequently, clot formation. MTS predisposes to extensive deep venous thrombosis (DVT) of the left lower extremity [ 1 , 2 ]. It is estimated to be the cause of about 2%-3% of all DVTs.…”

“…The incidence appears to be higher in women than in men. Additionally, patients are usually asymptomatic unless provoked by a predisposing condition for hypercoagulability, such as surgery, pregnancy, or postpartum state [ 1 ]. Here, we discuss a rare case where the risk factor for thromboembolism in MTS is observed as a complication from COVID-19 vaccination.…”

Staged Treatment of Phlegmasia Cerulea Dolens in a Patient with Iliac Vein Compression Syndrome and Deep Vein Thrombosis: A Case Report

“…There are no evidence-based protocols to guide treatment of PCD owing to its low prevalence. Among therapy options, catheter-directed thrombolysis [ 10 - 15 ], percutaneous thrombectomy [ 16 , 17 ], and surgical thrombectomy [ 18 , 19 ] can be highlighted.…”

“…Anticoagulation is an initial measure to prevent thrombus propagation [ 10 - 17 , 19 ]. Combining anticoagulation with a thrombus removal strategy, as performed in our case, appears to be the best option for treating extensive DVT involving the iliac segment.…”