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

Phlebology. 2020 Oct;35(9):701-705. doi: 10.1177/0268355520935744. Epub 2020 Jun 24.

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.

Keywords: Ischemia; thrombectomy; thrombophlebitis; venous thrombosis.

MeSH terms

  • Humans
  • Ischemia / diagnostic imaging
  • Ischemia / surgery
  • Thrombectomy
  • Thrombophlebitis* / diagnostic imaging
  • Thrombophlebitis* / therapy
  • Veins
  • Venous Thrombosis* / diagnostic imaging
  • Venous Thrombosis* / therapy