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Phlegmasia Caerulea Dolens in a Patient With an Inferior Vena Cava Filter: Treatment of Massive Iliocaval Thrombosis Using Local Intravenous Catheter-Directed Thrombolysis

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Abstract

Phlegmasia caerulea dolens (PCD) is a potentially disastrous complication of inferior vena cava filter insertion, and its optimum management has not been clearly established. We present a case report of a patient with pulmonary embolism and acute adrenal haemorrhage who developed PCD secondary to massive iliocaval thrombosis after insertion of a Cook Celect removable filter. Local intravenous catheter-directed thrombolysis (CDT), followed by systemic anticoagulation, achieved limb salvage and virtual resolution of symptoms at 3 months without complications. CDT can be a successful primary treatment of filter-associated PCD and can be safe in selected patients with acute nontraumatic haemorrhage. Systemic anticoagulation may subsequently restore complete venous patency and may therefore be a useful approach to postthrombolysis management of residual iliocaval thrombus when filter removal is indicated.

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The authors declare no financial support or conflicts of interest.

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Authors and Affiliations

  1. Department of Radiology, Middlemore Hospital, Auckland, 1640, New Zealand

    Daniel Cookson

  2. Department of Vascular Surgery, Middlemore Hospital, Auckland, 1640, New Zealand

    Stuart Caldwell

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  1. Daniel Cookson
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  2. Stuart Caldwell
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Correspondence to Daniel Cookson.

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Cookson, D., Caldwell, S. Phlegmasia Caerulea Dolens in a Patient With an Inferior Vena Cava Filter: Treatment of Massive Iliocaval Thrombosis Using Local Intravenous Catheter-Directed Thrombolysis. Cardiovasc Intervent Radiol 35, 1226–1230 (2012). https://doi.org/10.1007/s00270-011-0314-8

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  • DOI: https://doi.org/10.1007/s00270-011-0314-8

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