Management of Phlegmasia Cerulea Dolens with Percutaneous Mechanical Thrombectomy
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CASE REPORT
Management of Phlegmasia Cerulea Dolens with Percutaneous Mechanical Thrombectomy Ramsey A. Al-Hakim1 • Alexander Boscanin1 • David D. Prosser1 John A. Kaufman1
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Received: 12 May 2020 / Accepted: 20 June 2020 Ó Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2020
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. Keywords Mechanical thrombectomy Phlegmasia cerulea dolens Deep venous thrombosis
Introduction Phlegmasia cerulea dolens (PCD) is an uncommonly encountered severe form of deep venous thrombosis causing poor tissue perfusion with resultant high morbidity and mortality, particularly if presentation includes venous gangrene [1]. Treatment options include surgical embolectomy and catheter-based approaches such as catheter-directed thrombolysis and pharmacomechanical thrombus removal, but due to the overall uncommon presentation treatment algorithms are highly variable [1]. However, more severe cases 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 of tissue loss. We present a case of PCD with absent pedal pulses and sensory deficit managed successfully with percutaneous mechanical thrombectomy and stenting with immediate clinical resolution including restoration of pedal pulses.
Case Report
& Ramsey A. Al-Hakim [email protected] 1
Dotter Department of Interventional Radiology, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA
This single case report is exempt from institutional review board approval. A 63-year-old female with history of stage IVb vulvar squamous cell carcinoma presented with approximately 8 h of left lower extremity pain and swelling. Physical examination demonstrated left lower extremity swelling with discoloration/cyanosis, nondopplerable left dorsalis pedis and posterior tibial pulses, and diminished sensation in the left forefoot (Fig. 1A). Left lower extremity venous duplex demonstrated occlusive thrombus in the common femoral, deep femoral, femoral, popliteal, and calf veins as
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