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.

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.

scholarly journals Acute Limb Ischemia in Critically ill COVID-19 Patients: a Case Series and Literature Review

2021 ◽  
pp. 917-922
Author(s):  
Soumaya Touzani ◽  
Fatimazahra Haddari ◽  
Abderrahim Elbouazzaoui ◽  
Nawfal Houari ◽  
Brahim Boukatta ◽  
...  
Keyword(s):  
Respiratory Symptoms ◽  
Clinical Presentation ◽  
Case Series ◽  
Limb Ischemia ◽  
Acute Limb Ischemia ◽  
Vein Thrombosis ◽  
Life Threatening ◽  
The Mean ◽  
Deep Vein ◽  
Vascular Burden

Background: The vascular burden increased by COVID-19 infection and including acute limb ischemia (ALI) quickly emerged as a major medical challenge with devastating consequences such as limb loss, multiorgan dysfunction and death. We report a case series of COVID-19 infection associated with ALI to raise awareness and knowledge towards this life-threatening association. Methods: COVIDS-19 patients with acute limb ischemia (ALI) managed in a Moroccan 14 beds COVID-19 ICU between March 2020 and January 2021, were reviewed. Data collected included demographics, clinical presentation, treatments and outcomes. Results: Over the 10-month period, our ICU cared for 407 hospitalized patients with confirmed COVID-19. A total of 6 COVID-19 patients with ALI were identified. The mean age was 61 years (52 - 70) and 5 were men. The most common preexisting condition was diabetes (50%). The mean CRP level was 219 mg/L. Five patients had thrombus in multiple locations. No concomitant deep vein thrombosis was identified. Four patients presented with signs of acute No arterial ischemia with or without respiratory symptoms and were subsequently diagnosed with COVID-19. The remaining two patients developed ischemia during hospitalization. Mean SOFA score was 5 (2 -9). Respiratory support, corticosteroids and heparin therapies were used in all patients. Intubation and vasopressors were required in four patients. Revascularization was performed in five patients and reintervention was necessary in three cases. Four patients died in the ICU while two were successfully discharged. Conclusion: ALI in COVID-19 patients is a challenging life-threatening vascular emergency that requires appropriate multidisciplinary management (intensivists, anesthesiologists, vascular surgeons and interventionists, radiologists, haematologists…) and further studies focused on anticoagulation. Keywords: Acute Limb ischemia, Coagulopathy, COVID-19, SARS-CoV-2, Thrombosis

Phlegmasia cerulea dolens – an uncommon but alarming manifestation of deep vein thrombosis

VASA ◽  
2020 ◽  
Vol 49 (5) ◽  
pp. 422-426
Author(s):  
Manuela Nickler ◽  
Sebastian Haubitz ◽  
Adriana Méndez ◽  
Martin Gissler ◽  
Peter Stierli ◽  
...  
Keyword(s):  
Clinical Presentation ◽  
Treatment Options ◽  
Bleeding Risk ◽  
Venous Intervention ◽  
Aggressive Treatment ◽  
Vein Thrombosis ◽  
Prompt Treatment ◽  
Surgical Thrombectomy ◽  
Deep Vein ◽  
Phlegmasia Cerulea Dolens

Summary: In phlegmasia cerulea dolens (PCD), immediate diagnosis and prompt treatment is crucial for limb salvage. Aggressive treatment options including venous intervention, thrombolysis and/or surgical thrombectomy should be considered. Due to the lack of data, the most appropriate intervention depends upon etiology of PCD, clinical presentation and patient’s bleeding risk.

scholarly journals Percutaneous thrombectomy using a novel single session device for acute iliofemoral deep vein thrombosis

VASA ◽  
2021 ◽  
Vol 50 (1) ◽  
pp. 74-77
Author(s):  
Gerard O’Sullivan
Keyword(s):  
Deep Vein Thrombosis ◽  
Iliac Vein ◽  
Left Thigh ◽  
Common Iliac Vein ◽  
Single Session ◽  
Venous Thrombectomy ◽  
Vein Thrombosis ◽  
Left Common Iliac Vein ◽  
Deep Vein ◽  
Percutaneous Thrombectomy

Summary: A 74-year-old woman presented with acute symptomatic left thigh and calf swelling; imaging demonstrated evidence of occlusive thrombosis from the upper left common iliac vein to the mid-thigh. Single session zero-thrombolysis venous thrombectomy was performed using the ReVeneTM Thrombectomy Catheter.

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

Angioseal use after antegrade femoral arteriotomy in patients undergoing percutaneous revascularization for critical limb ischemia: A case series

2007 ◽  
Vol 118 (3) ◽  
pp. 398-399 ◽  
Author(s):  
Giuseppe G.L. Biondi-Zoccai ◽  
Massimiliano Fusaro ◽  
Abdulkafi Tashani ◽  
Nadia Mollichelli ◽  
Massimo Medda ◽  
...  
Keyword(s):  
Critical Limb Ischemia ◽  
Case Series ◽  
Limb Ischemia ◽  
Percutaneous Revascularization

scholarly journals Special Conditions in Venous Thrombembolism – Case Series

PRILOZI ◽  
2019 ◽  
Vol 40 (2) ◽  
pp. 103-111
Author(s):  
Marijan Bosevski ◽  
Irena Mitevska ◽  
Marica Pavkovic ◽  
Milka Klincheva ◽  
Emilija Trajkovska Lazarova ◽  
...  
Keyword(s):  
Randomized Clinical Trials ◽  
Real Life ◽  
Case Series ◽  
Vascular Diseases ◽  
The Elderly ◽  
Hospital Death ◽  
High Risk Population ◽  
Vein Thrombosis ◽  
Cancer Associated Thrombosis ◽  
Deep Vein

Abstract Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is a preventable cause of in-hospital death, and one of the most prevalent vascular diseases. There is a lack of knowledge with regards to contemporary presentation, management, and outcomes of patients with VTE. Many clinically important subgroups (including the elderly, those with recent bleeding, renal insufficiency, disseminated malignancy or pregnant patients) have been under-represented in randomized clinical trials. We still need information from real life data (as example RIETE). The paper presents case series with VTE in special conditions, including cancer associated thrombosis, malignant homeopathies, as well in high risk population.

Sign in / Sign up

Export Citation Format

Share Document