Endoluminal Recanalization in a Patient with Phlegmasia Cerulea Dolens Using a Multimodality Approach

Vascular ◽  
2005 ◽  
Vol 13 (5) ◽  
pp. 313-317 ◽  
Author(s):  
Albeir Mousa ◽  
Peter Henderson ◽  
Rajeev Dayal ◽  
Joshua Bernheim ◽  
K. Craig Kent ◽  
...  
Keyword(s):  
Rare Complication ◽  
Vena Cava ◽  
Iliac Vein ◽  
Venous Occlusion ◽  
Leg Pain ◽  
Postphlebitic Syndrome ◽  
History Of ◽  
Venous Gangrene ◽  
Multimodality Approach ◽  
Phlegmasia Cerulea Dolens

Phlegmasia cerulea dolens, a rare complication of deep venous thrombosis, has traditionally been difficult to treat. The patient described in this report posed additional therapeutic challenges based on a history of heparin-induced thrombocytopenia. She presented with severe leg pain and swelling, and a venogram showed occlusion of both her inferior vena cava and right iliac vein. The use of a multimodality approach, both chemical and mechanical, was successful in removing the venous occlusion, thereby preventing further complications, such as circulatory shock, postphlebitic syndrome, and venous gangrene.

scholarly journals Huge Intravascular Tumor Extending to the Heart: Leiomyomatosis

2015 ◽  
Vol 2015 ◽  
pp. 1-3 ◽  
Author(s):  
Suat Doganci ◽  
Erkan Kaya ◽  
Murat Kadan ◽  
Kubilay Karabacak ◽  
Gökhan Erol ◽  
...  
Keyword(s):  
Inferior Vena Cava ◽  
Right Atrium ◽  
Inferior Vena ◽  
Median Sternotomy ◽  
Vena Cava ◽  
Iliac Vein ◽  
Venous Occlusion ◽  
Right Atrial ◽  
High Recurrence Rate ◽  
Warfarin Sodium

Intravenous leiomyomatosis (IVL) is a rare neoplasm characterized by histologically benign-looking smooth muscle cell tumor mass, which is growing within the intrauterine and extrauterine venous system. In this report we aimed to present an unusual case of IVL, which is originating from iliac vein and extended throughout to right cardiac chambers. A 49-year-old female patient, who was treated with warfarin sodium due to right iliac vein thrombosis, was admitted to our department with intermittent dyspnea, palpitation, and dizziness. Physical examination was almost normal except bilateral pretibial edema. On magnetic resonance venography, there was an intravenous mass, which is originated from right internal iliac vein and extended into the inferior vena cava. Transthoracic echocardiography and transesophageal echocardiography revealed a huge mass extending from the inferior vena cava through the right atrium, with obvious venous occlusion. Thoracic, abdominal, and pelvic MR showed an intravascular mass, which is concordant with leiomyomatosis. Surgery was performed through median sternotomy. A huge mass with 25-cm length and 186-gr weight was excised through right atrial oblique incision, on beating heart with cardiopulmonary bypass. Histopathologic assessment was compatible with IVL. Exact strategy for the surgical treatment of IVL is still controversial. We used one-stage approach, with complete resection of a huge IVL extending from right atrium to right iliac vein. In such cases, high recurrence rate is a significant problem; therefore it should be kept in mind.

scholarly journals Atypical Presentation of Central Venous Occlusion (CVO) Disease

2019 ◽  
Vol 9 (1) ◽  
pp. 268-270
Author(s):  
Rosnelifaizur R*,Aizat Sabri I, Krishna K,Lenny SS,Azim I, H Harunarashid
Keyword(s):  
Superior Vena ◽  
Vena Cava ◽  
Lymphatic Vessels ◽  
Venous Access ◽  
Venous Occlusion ◽  
Intermittent Fever ◽  
Fluid Analysis ◽  
History Of ◽  
The Right ◽  
End Stage

We reported a case of 58 years old gentleman who known case of end stage renal failure and had history of Right IJC cannulation of venous access on 2012, presented with recurrent shortness of breath, chesty cough and intermittent fever. Otherwise he got no hemoptysis, no recent contact with PTB patients and no joint pain. The same presentation occurred last month with a pleural tapping was done and claimed it was a milky content. No further investigation was done at that moment. This current presentation noted a dullness in percussion up to midzone of right lung and reduce air entry on auscultation as well. The pigtail catheter was inserted over the right pleural space and it was confirmed as a chylothorax with a present of cholesterol in a pleural fluid analysis. Computed tomography of the thorax showed complete occlusion of the superior vena cava with an established collateral circulation. Lymphangiogram revealed lipiodol seen opacified lymph node and lymphatic vessels until the level of T3 on the right and T5 on the left. There was no obvious lipiodol opacification seen at the region of the right thorax. Effusion was improved after the instillation of fibrinolytic agent and the the chest radiograph shows improvement.

scholarly journals Management of Phlegmasia Cerulea Dolens Caused by a Giant Leiomyoma

2021 ◽  
Author(s):  
Elisabeth Ekkel ◽  
Tara Chandran ◽  
Ryan Qasawa ◽  
Michael Trpkovski ◽  
Sachinder Hans
Keyword(s):  
Uterine Leiomyoma ◽  
Inferior Vena ◽  
Mechanical Thrombectomy ◽  
Vena Cava ◽  
Iliac Vein ◽  
Young Female ◽  
Common Iliac Vein ◽  
Venous Obstruction ◽  
Recurrent Thrombosis ◽  
Phlegmasia Cerulea Dolens

Abstract This case is of a young female with a large uterine leiomyoma causing phlegmasia cerulea dolens with thrombosis of the left common and left external iliac veins. She underwent mechanical thrombectomy to temporize the condition until she could be evaluated by gynecology-oncologist to remove the cause of venous obstruction. Prior to hysterectomy, suprarenal inferior vena cava filter was placed. Less than 12 hours post hysterectomy she developed recurrent thrombosis involving the left common and external iliac veins. She underwent repeat mechanical thrombectomy with wall stent placement in the left common iliac vein with resolution of her symptoms.

scholarly journals Phlegmasia Cerulea Dolens: A Life- and Limb-threatening Disease

2021 ◽  
Vol 5 (0-2) ◽  
pp. 16
Author(s):  
Wan Nuraisyah Azzahrah Wan Zuki
Keyword(s):  
Venous Thrombosis ◽  
Lower Limb ◽  
Early Recognition ◽  
Vena Cava ◽  
Common Iliac Vein ◽  
Venous Thrombectomy ◽  
Catheter Directed Thrombolysis ◽  
Left Lower Limb ◽  
History Of ◽  
Phlegmasia Cerulea Dolens

Phlegmasia cerulea dolens (PCD) is a rare syndrome caused by venous thrombosis and characterised by a triad of limb oedema, cyanosis and pain. It requires early recognition as delay of treatment can cause gangrene, limb amputation and in extreme cases, death. A 67- year-old Chinese lady, with underlying hypertension, diabetes mellitus and dyslipidaemia presented to the emergency department with a 2 days history of pain, oedema and bluish discoloration over the entire left leg. She had a history of fall 6 months prior and since then she used a walking stick for mobilization. This patient underwent ultrasound doppler left lower limb , which showed features suggestive of long-segment left lower limb deep vein thrombosis. A diagnosis of PCD was made. Subsequently, she went for a CT angiogram and venography of the left lower limb which confirmed thrombosis of the left calf vein extending to the long segment of the left common iliac vein. She was commenced on intravenous heparin infusion and then underwent inferior vena cava filter insertion and catheter directed thrombolysis. Repeat venogram showed successful catheter directed thrombolysis of the left lower limb deep venous thrombosis (DVT). Treatment should be initiated as soon as the diagnosis of PCD is suspected. Currently, guidelines for treatment are lacking however 3 therapeutic options are advocated alone or in combination: anticoagulants, thrombolytic therapy, and venous thrombectomy. An early recognition of PCD and appropriate decision regarding the treatment is essential to preserve the limb.International Journal of Human and Health Sciences Supplementary Issue-2: 2021 Page: S16

Effects of Bariatric Surgery Observed in Postmortem Toxicology Casework

2019 ◽  
Vol 43 (8) ◽  
pp. 651-659 ◽  
Author(s):  
Sandra C Bishop-Freeman ◽  
Olivia Skirnick ◽  
Chelsea N Noble ◽  
David H Eagerton ◽  
Ruth E Winecker
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Vena Cava ◽  
Iliac Vein ◽  
The Body ◽  
Manner Of Death ◽  
Case Examples ◽  
The North ◽  
Postmortem Toxicology ◽  
History Of

Abstract Bariatric surgery has been on the rise and patients often have multiple indications for pre- and post-operative pharmacotherapy. Procedures target the stomach and/or small intestine and affect weight loss through restriction, malabsorption, or a combination of the two. The absorption and/or metabolism of drugs via the gastrointestinal tract could be altered by different mechanisms. Several cases at the North Carolina Office of the Chief Medical Examiner’s Toxicology Laboratory (NCOCME) have raised questions about the potential impact of these procedures on the disposition of drugs in the body and how that altered disposition may affect cause and manner of death. Overmedication and postmortem redistribution are not enough to explain the phenomena seen in some NCOCME bariatric surgery-related casework. Case examples include a 46-year-old female with a history of Roux-en-Y gastric bypass (RYGB) who suffered a witnessed collapse. Toxicological findings included elevated concentrations of oxymorphone at 0.49 mg/L in vena cava blood. A 67-year-old female, who died from vomiting and bacterial gastritis one day after placement of two intragastric weight-loss balloons, had elevated concentrations of duloxetine at 1.4 mg/L in the iliac vein blood and 9.3 mg/kg in the liver. Her medication was strictly controlled by her sister and gastric contents were without intact tablets or residue at autopsy.

scholarly journals Combined Vascular and Orthopaedic Approach for a Pseudotumor Causing Deep Vein Thrombosis after Metal-on-Metal Hip Resurfacing Arthroplasty

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Hossam Abdel-Hamid ◽  
Jonathan Miles ◽  
Richard W. J. Carrington ◽  
Alister Hart ◽  
Alex Loh ◽  
...  
Keyword(s):  
Lower Limb ◽  
Rare Complication ◽  
Vena Cava ◽  
Pelvic Mass ◽  
Iliac Vein ◽  
Hip Resurfacing ◽  
Metal Debris ◽  
Left Groin ◽  
Soft Tissue Necrosis ◽  
Metal On Metal

Introduction. Metal-on-metal (MoM) hip resurfacings have been associated with a variety of complications resulting from adverse reaction to metal debris. Pseudotumors have rarely been reported to cause deep venous thrombosis (DVT).Study Design. A case report and a review of the literature.Case Presentation. A 75-year-old female who had left metal-on-metal hip resurfacing 6 years ago presented with left groin pain associated with unilateral lower limb edema and swelling. By duplex and MRI studies, our patient had an extensive soft tissue necrosis associated with a large pelvic mass causing extensive DVT of the lower limb secondary to mechanical compression of the left iliac vein.Results. Our case was initially treated for DVT followed by dual surgical approach. The pseudotumor was excised through a separate iliofemoral approach and revision of the hip implant was undertaken through a posterior approach in the same setting. An inferior vena cava (IVC) filter was inserted to minimise the perioperative risks of handling the iliac veins.Conclusion. A combined approach with vascular surgeons is required. Combined resection of the pseudotumor and revision of the metal bearing surfaces is essential, in order to achieve a good surgical outcome in this rare complication.

Management of Post-Traumatic Phlegmasia Cerulea Dolens via Right-to-Left Femoral Vein to Femoral Vein Bypass (Palma Procedure)

2017 ◽  
Vol 51 (8) ◽  
pp. 567-571 ◽  
Author(s):  
Anahita Dua ◽  
Jennifer Heller ◽  
Cheong Lee
Keyword(s):  
Clinical Presentation ◽  
Femoral Vein ◽  
Rare Condition ◽  
Operative Management ◽  
Iliac Vein ◽  
Venous Occlusion ◽  
Diagnostic Process ◽  
Vein Bypass ◽  
Post Traumatic ◽  
Phlegmasia Cerulea Dolens

Phlegmasia cerulea dolens (PCD) is a rare condition resulting from venous occlusion that impairs arterial flow. We report a rare case of post-traumatic PCD after ligation of the iliac vein with successful treatment by right-to-left femoral vein to femoral vein bypass using left great saphenous vein (Palma procedure). The clinical presentation, diagnostic process, and approach to management along with a literature review on the operative management of PCD are presented in this case report.

Percutaneous iliac vein recanalization 17 years after thrombotic occlusion

VASA ◽  
2009 ◽  
Vol 38 (1) ◽  
pp. 76-79 ◽  
Author(s):  
Beschorner ◽  
Schwarz ◽  
Rastan ◽  
Sixt ◽  
Noory ◽  
...  
Keyword(s):  
Symptom Relief ◽  
Vena Cava ◽  
Iliac Vein ◽  
Postthrombotic Syndrome ◽  
Venous Stenting ◽  
Patient Reported ◽  
History Of ◽  
Venous Outflow Obstruction ◽  
Venous Claudication

Persistent venous outflow obstruction of the iliac veins is one of the mechanisms that seem to portend the greatest risk for late development of severe complications. We report the case of a 42-year-old male with postthrombotic occlusion of the left external iliac vein since the age of 25. We managed to recanalize the obstructed vessel and establish a good flow into the inferior vena cava by venous stenting. After successful intervention the patient reported instant symptom relief and was free from venous claudication and leg heaviness at the 6 month follow-up examination. Even after long history of postthrombotic syndrome, venous stenting can be an option for patients with chronic outflow obstructions of the iliac veins.

scholarly journals Iliac vein aneurysms: a comprehensive review

2019 ◽  
Vol 11 (1) ◽  
pp. 1-7
Author(s):  
Sina Zarrintan ◽  
Niki Tadayon ◽  
Seyed Moahammad Reza Kalantar-Motamedi
Keyword(s):  
Inferior Vena ◽  
Vena Cava ◽  
Iliac Vein ◽  
Systematic Search ◽  
Endovascular Techniques ◽  
Previous Trauma ◽  
Internal Iliac ◽  
History Of ◽  
Open Surgical Treatment ◽  
Age Range

Introduction: Iliac vein aneurysm is a rare clinical entity. Iliac venous tract is the least commonlocation for venous aneurysms. There are a few cases of common, external and internal iliac veinaneurysms in the literature. However, undiagnosed and ruptured iliac venous aneurysms couldhave hazardous consequences. Herein, we reviewed all literature cases of iliac vein aneurysms.Their potential diagnostic and therapeutic challenges are discussed. Literature Review: Following a systematic search, 50 cases of iliac venous aneurysms wereidentified. We used MEDLINE [1900-March 2018] and EMBASE [until March 2018]. MeSHterms of iliac vein/veins/venous, hypogastric, inferior vena cava and aneurysm/aneurysms wereused. Fifty patients with venous aneurysms located in common, external or internal iliac veinswere found in our systematic search. Seventeen patients were female (35.4%) and 31 patients weremale (64.6%). The age range was 13 to 70 years of age. The aneurysm was located in right side in17 patients (34%). It was located in left side in 29 patients (58%) and it was bilateral in 4 patients(8%). The aneurysm was located in common, external and internal iliac veins in 15 (30%), 31(62%) and 4 (8%) patients respectively. The aneurysm was due to a previous arteriovenousfistula (AVF) in 19 patients (38%) and of them, 16 patients (32%) had a history of AVF resultingfrom a previous trauma. 29 patients (59.2%) underwent open surgical treatment. Five patients(10.2%) underwent endovascular treatment. One patient (2.0%) underwent hybrid treatment.Conservative treatment was used in 14 patients (28.6%). Conclusion: Iliac vein aneurysms are extremely rare. Its diagnosis necessitates precise clinicalsuspicion and the treatment is based on patients’ clinical scenario and radiological features. Bothopen and endovascular techniques could be feasible. Iliac vein aneurysms are more commonin men. Left sided aneurysms are more common. The most common anatomic location isexternal iliac vein. The most common cause of iliac aneurysms is dilatation of vein secondary toa traumatic AVF.

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