Phlegmasia cerulea dolens

Is it is 1114common severe form of deep venous thrombosis which results from extensive thrombotic occlusion of the major and the collateral veins of an extremity.

Characterized by sudden pain, swelling, cyanosis and edema of the affected limb.

PCD is an emergent situation that can lead to loss of limb and hypovolemic shock secondary to massive fluid sequestration.

Diagnosis requires a high level of suspicion as indicated by sudden severe leg pain, marked extremity swelling, cyanosis, edema, firmness, venous gangrene, and arterial compromise.

Associated with a high risk of pulmonary embolism.

May be associated with gangrene.

Threatens life and limb.

An underlying malignancy is found in 50% of cases.

Thrombosis extends to collateral veins, resulting in venous congestion with massive fluid sequestration and edema.

40-60% also have capillary involvement, resulting in irreversible venous gangrene that involves the skin, subcutaneous tissue, or muscle.

The hydrostatic pressure in arterial and venous capillaries exceeds the oncotic pressure, causing fluid sequestration in the interstitium.

Massive fluid sequestration may result in circulatory insufficiency in about one third of patients, and arterial insufficiency may occur.

The left lower extremitiy is involved 3:1-4:1 ratio over the right lower extremity.

Involvement of upper extremities occurs in less than 5% of cases.

In phlegmasia alba dolens massive thrombosis of deep and superficial veins occurs with preservation of collateral vessel patency.

50-60% are preceded by phlegmasia alba dolens, with symptoms of edema, pain, and blanching, without cyanosis.

In PCD the collateral blood vessels are also thrombosed.

Patients present with edema, severe pain, and cyanosis.

The presence of massive fluid in the extremity may lead to bleb and bullae formation.

The pain is constant, and cyanosis is the pathognomonic.

May result in venous gangrene, and if muscular involvement occurs arterial gangrene may occur.

Management requires multi-disciplinary approach including vascular surgery, interventional radiology.

Selected patients may benefit from thrombus removal.

Available management approaches include percutaneous venous thrombectomy, catheter directed thrombolysis, systemic thrombolysis, and operative venous thrombectomy.

Percutaneous venous thrombectomy is associated with frequent recurrences.

Catheter directed thrombolysis is the pref2242ed management.

Systemic thrombolysis and operative venous thrombectomy or are second line considerations.

Patients with extensive DVT and large thrombus burden, such as a ilio femoral clot, may benefit from thrombectomy.

Operative venous thrombectomy is considered for patients with less than seven days of symptoms.

Patients with smaller thrombus burden can be treated with anticoagulation alone.

Thromblysis therapy may be indicated for patients with extensive DVT, with symptoms lasting less than 14 days.

Catheter directed thrombolysis utilizes a catheter introduced into the popliteal for lower calf vein with the infusion of tissue plasminogen activator directly into the clot.

In the above procedure, the catheter is advanced of the leg into new clot, as the old clot dissolves.

After completion of thrombolysis, standard anticoagulation therapy is continued.

PCD and compartmental syndrome have a common final pathway, compression of arterial vessels secondary to increased pressure in the lower extremity compartment.

PCD results in inflow impairment by massive fluid extravasation into tissues related to extensive obstructive venous outflow by DVT.

Leave a Reply

Your email address will not be published. Required fields are marked *