Phlegmasia coerulea dolens

Hummel, Thomas; Wenkel, M.; Papapostolou, G.; Mühlberger, Dominic; Mumme, A.

doi:10.1007/s00772-016-0211-1

Cited by 3 publications

(1 citation statement)

References 16 publications

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“…In non-atherosclerotic lesions, accounting for 10 to 15 % of the cases, thromboembolism occurs when a blood clot travels from another region, such as the heart or aneurysmal arteries, and causes an arterial blockage [3] . In other specific conditions, such as paradoxical embolism or phlegmasia cerulea dolens, the resulting embolism has a venous origin [4] .…”

Section: Introductionmentioning

confidence: 99%

Sudden development of the upper and lower limb ischemia as the first manifestation of COVID-19 infection

Aliasgarzadeh

Arabzadeh

Fathibitaraf

et al. 2022

International Journal of Surgery Case Reports

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Section: Introductionmentioning

confidence: 99%

Sudden development of the upper and lower limb ischemia as the first manifestation of COVID-19 infection

Aliasgarzadeh

Arabzadeh

Fathibitaraf

et al. 2022

International Journal of Surgery Case Reports

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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

et al. 2020

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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.

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Acute Limb Ischemia—Much More Than Just a Lack of Oxygen

Simon

Oberhuber

Floros

et al. 2018

IJMS

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Acute ischemia of an extremity occurs in several stages, a lack of oxygen being the primary contributor of the event. Although underlying patho-mechanisms are similar, it is important to determine whether it is an acute or chronic event. Healthy tissue does not contain enlarged collaterals, which are formed in chronically malperfused tissue and can maintain a minimum supply despite occlusion. The underlying processes for enhanced collateral blood flow are sprouting vessels from pre-existing vessels (via angiogenesis) and a lumen extension of arterioles (via arteriogenesis). While disturbed flow patterns with associated local low shear stress upregulate angiogenesis promoting genes, elevated shear stress may trigger arteriogenesis due to increased blood volume. In case of an acute ischemia, especially during the reperfusion phase, fluid transfer occurs into the tissue while the vascular bed is simultaneously reduced and no longer reacts to vaso-relaxing factors such as nitric oxide. This process results in an exacerbative cycle, in which increased peripheral resistance leads to an additional lack of oxygen. This whole process is accompanied by an inundation of inflammatory cells, which amplify the inflammatory response by cytokine release. However, an extremity is an individual-specific composition of different tissues, so these processes may vary dramatically between patients. The image is more uniform when broken down to the single cell stage. Because each cell is dependent on energy produced from aerobic respiration, an event of acute hypoxia can be a life-threatening situation. Aerobic processes responsible for yielding adenosine triphosphate (ATP), such as the electron transport chain and oxidative phosphorylation in the mitochondria, suffer first, thus disrupting the integrity of cellular respiration. One consequence of this is irreparable damage of the cell membrane due to an imbalance of electrolytes. The eventual increase in net fluid influx associated with a decrease in intracellular pH is considered an end-stage event. Due to the lack of ATP, individual cell organelles can no longer sustain their activity, thus initiating the cascade pathways of apoptosis via the release of cytokines such as the BCL2 associated X protein (BAX). As ischemia may lead to direct necrosis, inflammatory processes are further aggravated. In the case of reperfusion, the flow of nascent oxygen will cause additional damage to the cell, further initiating apoptosis in additional surrounding cells. In particular, free oxygen radicals are formed, causing severe damage to cell membranes and desoxyribonucleic acid (DNA). However, the increased tissue stress caused by this process may be transient, as radical scavengers may attenuate the damage. Taking the above into final consideration, it is clearly elucidated that acute ischemia and subsequent reperfusion is a process that leads to acute tissue damage combined with end-organ loss of function, a condition that is difficult to counteract.

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Phlegmasia coerulea dolens

Cited by 3 publications

References 16 publications

Sudden development of the upper and lower limb ischemia as the first manifestation of COVID-19 infection

Sudden development of the upper and lower limb ischemia as the first manifestation of COVID-19 infection

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

Acute Limb Ischemia—Much More Than Just a Lack of Oxygen

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