A rare case of phlegmasia cerulea dolens complicated with iliac vein perforation

A rare case of phlegmasia cerulea dolens complicated with iliac vein perforation

Che-Yan Liu¹, MD; Nai-Yu Chi^1,2, MD; Ho-Ming Su^1,2,3, MD; Tsung-Hsien Lin^{1, 2,3}, MD, PhD; Po-Chao Hsu ^1,2,3,MD, PhD*

¹Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; ²Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; ³Department of Internal Medicine, Faculty of Medicine, School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

Venous thromboembolism (VTE) is a major healthcare problem in the world. It includes pulmonary embolism and deep vein thrombosis (DVT) that result in significant morbidity and mortality. Phlegmasia cerulea dolens (PCD) is a rare but potentially life-threatening severe form of acute DVT, which is characterized by marked swelling of the extremities with pain and cyanosis, and further leads to arterial ischemia due to venous hypertension and compartment syndrome, and ultimately cause gangrene with high amputation and mortality rates. However, there was rare case reported about PCD complicated with venous perforation. Herein, we report a scarce case of left iliofemoral DVT suffering from iliac vein perforation with extraperitoneal hematoma. Although this case treated by iliac vein stenting with cover stent and ultrasound-assisted thrombolysis (EKOS). Patient still finally received below the knee amputation due to reperfusion injury over distal foot despite great improved venous blood flow. Our case should be the first case of PCD complicated with venous perforation. This rare case reminds physicians that venous perforation is a possible complication of PCD and may lead to poor outcome. Early hemostasis by stenting and performing thrombectomy treatment as soon as possible is suggested to save the life and limb.

Keywords: deep vein thrombosis; phlegmasia cerulea dolens; ultrasound-assisted thrombolysis; venous perforation

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How to cite this article:

Che-Yan Liu; Nai-Yu Chi; Ho-Ming Su; Tsung-Hsien Lin; Po-Chao Hsu. A rare case of phlegmasia cerulea dolens complicated with iliac vein perforation. International Journal of Case Reports, 2023, 7:287. DOI: 10.28933/ijcr-2023-01-1606cyl

References:

1. Lai HT, Huang SH: Phlegmasia Cerulea Dolens with Compartment Syndrome. N Engl J Med. 2018 Feb 15;378(7):658.
2. Wakefield TW: Treatment algorithm for acute deep venous thrombosis: current guidelines. In: Gloviczki P, editor. Handbook of venous disorders. 3rd ed. London: Hodder Arnold; 2009. p. 265-276.
3. Chinsakchai K, Ten Duis K, Moll FL, de Borst GJ: Trends in management of phlegmasia cerulea dolens. Vasc Endovascular Surg 2011;45:5‐14.
4. Abootalebi A, Salemi M, Heidari F, Azimi Meibody A: Phlegmasia cerulea dolens: a rare case report. Adv Biomed Res. 2020, 9:31.
5. Patel NH, Plorde JJ, Meissner M: Catheter-directed thrombolysis in the treatment of phlegmasia cerulea dolens. Ann Vasc Surg 1998;12:471- 475.
6. Bazan HA, Reiner E, Sumpio B: Management of bilateral phlegmasia cerulea dolens in a patient with subacute splenic laceration. Ann Vasc Dis 2008; 1: 45-8.