Department of Radiology, Middlemore Hospital, Auckland, New Zealand.
Cardiovasc Intervent Radiol. 2012 Oct;35(5):1226-30. doi: 10.1007/s00270-011-0314-8. Epub 2011 Dec 3.
Phlegmasia caerulea dolens (PCD) is a potentially disastrous complication of inferior vena cava filter insertion, and its optimum management has not been clearly established. We present a case report of a patient with pulmonary embolism and acute adrenal haemorrhage who developed PCD secondary to massive iliocaval thrombosis after insertion of a Cook Celect removable filter. Local intravenous catheter-directed thrombolysis (CDT), followed by systemic anticoagulation, achieved limb salvage and virtual resolution of symptoms at 3 months without complications. CDT can be a successful primary treatment of filter-associated PCD and can be safe in selected patients with acute nontraumatic haemorrhage. Systemic anticoagulation may subsequently restore complete venous patency and may therefore be a useful approach to postthrombolysis management of residual iliocaval thrombus when filter removal is indicated.
疼痛性蓝色淤滞症（PCD）是下腔静脉滤器置入的一种潜在灾难性并发症，其最佳治疗方法尚未明确。我们报告了 1 例因急性肾上腺出血而接受 Cook Celect 可回收滤器置入的肺栓塞患者，该患者在滤器置入后发生大量髂股静脉血栓形成，继而发展为 PCD。局部静脉置管溶栓（CDT）后联合全身抗凝治疗 3 个月后，肢体得以保留，症状基本缓解，无并发症发生。CDT 可作为滤器相关性 PCD 的有效初始治疗方法，对于急性非创伤性出血的特定患者而言较为安全。全身抗凝治疗可能会恢复完全的静脉通畅，因此，对于需要取出滤器的患者，在溶栓治疗后处理残余髂股静脉血栓时，这可能是一种有用的方法。
