Volumen: 13 # Number : 2
Publication Date : Mayo - Agosto Year: 2009
Authors: Andrés Lázaro Brodsky, Marcelo José Melero, Carlos Darío Carbia
Abstract: Diagnosis and treatment of phlegmasia cerulea dolens.
Phlegmasia cerulea dolens (PCD) and venous gangrene
(VG) are infrequent and severe complications of deep vein
trombosis. If thrombosis is massive, completely occluding
the venous outflow of the affected limb, tissue ischemia
ensues (PCD). With ongoing circulatory impairment, tissue damage evolves to necrosis, with limb and/or life loss.
Early clinical recognition of PCD (characterized by excruciating
pain, massive edema, erythema and cyanosis of
involved limb) allows an immediate and aggressive limb
saving treatment to restore venous outflow. We suggest
–besides local and general support therapy and immediate
intravenous anticoagulation of PCD– chemical and mechanical
endovascular thrombolysis should be the first
approach. This generally leads to a quick venous repermeabilization
with clinical resolution. If endovascular
thrombolysis is unavailable, systemic fibrinolysis seems the
best option to save the limb, although patency rates are
lower. In this setting, fasciotomies and vena cava filters are
contraindicated.
Key words: deep vein thrombosis, phlegmasia cerulea
dolens, venous gangrene, thrombophilia, inferior vena cava
filter, thrombolysis.
Pages : 68-72
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