Phlegmasia Caerulea Dolens and Venous Gangrene
Abstract
Objectives: Phlegmasia caerulea dolens (PCD) and venous gangrene are rare conditions of severe form of lower extremity acute deep vein thrombosis (DVT) that trend to occur in association with malignancy and hypercoagulable state. Our aim is to evaluate the results of surgical management in 15 patients with PCD and venous gangrene in 125 DVT patients.
Methods: This is a 12 year (140 months) retrospective study in management of 6 PCD and 9 venous gangrene patients from total 125 patients with acute DV'T of lower extremities seen at Chiang Mai University Hospital and nearby private hospitals from January 1991 to August 2002.
Results: Six patient with impending gangrene and failure from initial management of bed rest, extremity elevation, fluid resuscitation and systemic anticoagulation for 6-12 hours underwent iliofemoral venous thrombectomy and distal arteriovenous fistula. All of these patients achieved limb salvage. In other nine patients with venous gangrene underwent iliofemoral thrombectory, 2 caval interruption, inevitable below knee and transmetatarsal amputation was perfomed after improved leg oedema. There was no pulmonary embolism (PE) or immediated mortality.
Conclusion: Venous thrombectomy with temporary distal arteriovenous fistula are indicated for treatment of PCD after failure of anticoagulation or impending venous gangrene. In patients with venous gangrene, thrombectomy can decreased oedema, limited extension of gangrene with preservation the length of leg amputation and reduced the rate of pulmonary embolism. Venous thrombectomy should be reserved for patients with contraindications to thrombolysis or in condition that thrombolytic therapy is not available.
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