Venous thrombectomy in cases of acute deep vein thrombosis presenting as acute limb ischemia (Phlegmasia Cerulea Dolens): report of 2 cases and review of literature

2013 ◽  
Vol 30 (1) ◽  
pp. 36-39 ◽  
Author(s):  
Vikas Deep Goyal ◽  
Bharti Gupta ◽  
Usha Choudhary ◽  
Pritesh Maheshwari ◽  
Dayashankar Iyer
Keyword(s):  
Deep Vein Thrombosis ◽  
Limb Ischemia ◽  
Acute Limb Ischemia ◽  
Review Of Literature ◽  
Venous Thrombectomy ◽  
Vein Thrombosis ◽  
Acute Deep Vein Thrombosis ◽  
Deep Vein ◽  
Phlegmasia Cerulea Dolens

Upper extremities deep vein thrombosis and DOAC treatment: a prospective cohort study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M.C Vedovati ◽  
G Tratar ◽  
A Mavri ◽  
L Pierpaoli ◽  
G Agnelli ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Pacemaker Implantation ◽  
Limb Ischemia ◽  
Central Venous Line ◽  
Upper Extremities ◽  
Acute Limb Ischemia ◽  
Vein Thrombosis ◽  
Deep Vein

Abstract Background Data on the use of direct oral anticoagulants (DOACs) in patients with upper extremities deep vein thrombosis (UEDVT) are limited. Purpose To assess the effectiveness and safety of DOACs in the treatment of UEDVT. Methods Data on patients with an objective diagnosis of acute UEDVT treated with DOACs were merged from prospective cohorts of patients with venous thromboembolism (VTE). Study outcomes were recurrent VTE and major bleeding (MB) occurring during DOAC treatment. Results Overall, 132 patients were included: mean age was 47.7±18.0 years (range 18 to 97), males were 42.4%. Twenty-seven percent of patients had 2 or more risk factors for VTE, 29.5% had UEDVT complicating a central venous line or after pacemaker implantation (Table). Ninety-two patients (70%) were managed as outpatients. Increased age (OR 1.03, 95% CI 1.0–1.05) and anemia (OR 1.35, 95% CI 1.07–1.70) were associated with in-patient management. Among patients treated with apixaban (40) or rivaroxaban (85) loading dose was used in 72%; in patients treated with dabigatran (5) or edoxaban (2) mean heparin pre-treatment was 8 days. DOACs were started after 1 month from UEDVT diagnosis in 12.9% of patients; active cancer was a main predictor for delayed initiation (OR 22.2, 95% CI 5.8–84.4). Mean treatment duration in patients with a scheduled stop was 4.9 months, while mean followup in those who continued DOACs was 9.3 months. No recurrence of VTE nor MBs occurred during DOAC treatment; one patient had acute limb ischemia (1.38% patient-year), 7 clinically relevant non-MBs (3 genital, 2 epistaxis, 1 gingival, 1 genital bleeding plus epistaxis; 10.51% patient-year), 5 deaths (4 cancer, 1 advanced age; 9.69% patient-year). Conclusions Our data support the effectiveness and safety of DOACs for the treatment of acute UEDVT. Further studies are required to confirm these findings. Funding Acknowledgement Type of funding source: None

scholarly journals Surgical Venous Thrombectomy for Japanese Patients with Acute Deep Vein Thrombosis: A Review of 5 Years' Experience

2010 ◽  
Vol 77 (3) ◽  
pp. 155-159 ◽  
Author(s):  
Noriyoshi Kutsukata ◽  
Kunihiro Mashiko ◽  
Hisashi Matsumoto ◽  
Yoshiaki Hara ◽  
Yuichiro Sakamoto ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Japanese Patients ◽  
Venous Thrombectomy ◽  
Vein Thrombosis ◽  
Acute Deep Vein Thrombosis ◽  
Deep Vein

scholarly journals Surgery for the Venous Disaster - Phlegmasia Cerulea Dolens

2019 ◽  
Vol 22 (4) ◽  
pp. E289-E293
Author(s):  
Chien-Hui Lee ◽  
Yung-Kun Hsieh
Keyword(s):  
Deep Vein Thrombosis ◽  
Venous Thrombosis ◽  
Endovascular Procedures ◽  
Venous Thrombectomy ◽  
Treatment Methods ◽  
Vein Thrombosis ◽  
Life Threatening ◽  
Deep Vein ◽  
Mid Term Results ◽  
Phlegmasia Cerulea Dolens

Phlegmasia cerulea dolens is an acute fulminating form of extensive venous thrombosis. Limb loss, post-thrombotic syndrome and life-threatening conditions can occur without appropriate management. Treatment methods vary; there presently is no consensus on the best form of treatment. Endovascular procedures have been a good option for treating deep vein thrombosis, yet they may be insufficient for patients suffering from phlegmasia cerulea dolens. Venous thrombectomy with the guidance of venography quickly relieves symptoms, hardly causes complications, yields optimal mid-term results, and can be a justifiable treatment for phlegmasia cerulea dolens.

Multimodal approach of venous recanalization in patients with a critical limb ischemia due to phlegmasia cerulea dolens: A case series of 17 patients in a single center

2020 ◽  
Vol 35 (9) ◽  
pp. 701-705
Author(s):  
Dominic Mühlberger ◽  
Achim Mumme ◽  
Markus Stücker ◽  
Stefanie Reich-Schupke ◽  
Thomas Hummel
Keyword(s):  
Critical Limb Ischemia ◽  
Case Series ◽  
Limb Ischemia ◽  
Venous Thrombectomy ◽  
Vein Thrombosis ◽  
Underlying Malignancy ◽  
High Urgency ◽  
Venous Recanalization ◽  
Deep Vein ◽  
Phlegmasia Cerulea Dolens

Objectives Advanced phlegmasia cerulea dolens can be a hazardous complication of a deep vein thrombosis and rapid recanalization of the deep venous system is the most important factor. Method We describe the outcome of 17 patients with critical limb ischemia due to an advanced phlegmasia cerulea dolens. Venous thrombectomy was performed by a standardized operating procedure. Results Venous recanalization was successful in all patients. An additional fasciotomy was not necessary. There were five patients with an underlying malignancy and eight patients with a simultaneous pulmonary embolism. We had one amputation of a forefoot and one death within 30 days representing a 30-day mortality and an amputation rate of 6%. Conclusions Early recanalization and recovery of the venous outflow is mandatory for success. A multimodal therapeutic approach of high urgency surgical thrombectomy in combination with endovenous strategies could be a successful treatment option for advanced phlegmasia cerulea dolens.

Acute Deep Vein Thrombosis Treated with Porcine Plasmin

1974 ◽  
Vol 32 (02/03) ◽  
pp. 468-482 ◽  
Author(s):  
O Storm ◽  
P Ollendorff ◽  
E Drewsen ◽  
P Tang
Keyword(s):  
Deep Vein Thrombosis ◽  
Lower Limb ◽  
Initial Dose ◽  
Treated Group ◽  
Allergic Reactions ◽  
Double Blind ◽  
Vein Thrombosis ◽  
Thrombolytic Effect ◽  
Acute Deep Vein Thrombosis ◽  
Deep Vein

SummaryThe thrombolytic effect of pig plasmin was tested in a double blind trial on patients with deep venous thrombosis in the lower limb. Only patients with not more than three days old thrombi were selected for this study. The diagnosis of deep vein thrombosis was made clinically and confirmed by phlebography. Lysofibrin Novo (porcine plasmin) or placebo (porcine plasminogen) was administered intravenously to the patients. The enzyme and the placebo were delivered as lyophilized powder in labelled bottles - the contents of the bottles were unknown to the doctor in charge of the clinical administration of the trial. An initial dose of plasmin/plasminogen of 30 unit per kg body weight given slowly intravenously (1-1% hours infusion) was followed by a maintenance dosis of 15 per cent the initial dose per hour for the following 5-7 hours. In most cases a similar maintenance dosis was given the next day. In all patients heparin was administered after ending the plasmin/plasminogen infusion. The results of the treatment was evaluated clinically as well as by control phlebo- grams the following days.A statistically significant improvement was found in the plasmin treated group compared with the placebo (plasminogen) treated group. Thrombolysis was obtained clinically and phlebographically in 65 per cent of the plasmin treated group, but only in 15 per cent of the control patients were improvements found.This study has thus demonstrated that plasmin treatment according to a standard scheme was able to induce thrombolysis. There were only a few and insignificant side effects. Allergic reactions have not been seen and only very simple tests are required.

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