Abstract
Advanced cases of phlegmasia cerulea dolens (PCD) with absent pedal pulses, sensory/motor deficits, and/or venous gangrene likely require more rapid restoration of flow compared to cases without these factors to prevent progression and associated morbidity/mortality. We present a case of PCD with absent pedal pulses and sensory deficit managed successfully with emergent percutaneous mechanical thrombectomy using Inari ClotTriever (Inari Medical, Irvine, CA) with immediate clinical resolution, including restoration of pedal pulses ~ 45 min after thrombectomy. Percutaneous mechanical thrombectomy with the ClotTriever device has the ability to immediately restore venous flow reversing the pathophysiology of PCD in a short time period similar to surgical embolectomy and may be an alternative treatment strategy in patients with phlegmasia cerulea dolens of high severity.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Chinsakchai K, Ten Duis K, Moll FL, de Borst GJ. Trends in management of phlegmasia cerulea dolens. Vasc Endovasc Surg. 2011;45(1):5–14.
Dempsey R. Phlegmasia cerulea dolens a complication of iliofemoral venous thrombosis. JDMS. 1994;10(2):89–94.
Dayal R, Bernheim J, Clair DG, Mousa AY, Hollenbeck S, DeRubertis B, et al. Multimodal percutaneous intervention for critical venous occlusive disease. Ann Vasc Surg. 2005;19(2):235–40.
Mouawad NJ. Effective single-session percutaneous nonpharmacologic mechanical thrombectomy for phlegmasia cerulea dolens. J Vasc Surg Cases Innov Tech. 2020;6(2):212–5.
Oguzkurt L, Ozkan U, Demirturk OS, Gur S. Endovascular treatment of phlegmasia cerulea dolens with impending venous gangrene: manual aspiration thrombectomy as the first-line thrombus removal method. Cardiovasc Intervent Radiol. 2011;34(6):1214–21.
Oguzkurt L, Tercan F, Ozkan U. Manual aspiration thrombectomy with stent placement: rapid and effective treatment for phlegmasia cerulea dolens with impending venous gangrene. Cardiovasc Intervent Radiol. 2008;31(1):205–8.
Sevuk U, Kose K, Ayaz F, Ozyalcin S. Successful treatment of phlegmasia cerulea dolens in a nonagenarian patient with chronic iliac vein occlusion using a Cleaner thrombectomy device. BMJ Case Rep. 2015;2015.
Acknowledgements
None.
Funding
This study was not supported by any funding.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
RA reports equity interest in Auxetics, Inc. JK reports consulting fees from BTG, personal fees from VIVA Physicians, royalties from Elsevier, stipend from ARRS/AJR, part ownership in Auxetics, Hatch Medical, Vu Medi, Endoshape, personal fees from Cook Medical, personal fees from Argon. Authors AB and DP declare that they have no conflict of interest.
Ethical Approval
For this type of study, formal consent is not required.
Informed Consent
For this type of study, informed consent is not required.
Consent for Publication
For this type of study, consent for publication is not required.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Al-Hakim, R.A., Boscanin, A., Prosser, D.D. et al. Management of Phlegmasia Cerulea Dolens with Percutaneous Mechanical Thrombectomy. Cardiovasc Intervent Radiol 43, 1398–1401 (2020). https://doi.org/10.1007/s00270-020-02570-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00270-020-02570-x