Orthopaedics and Traumatology Department - Cova da Beira University Hospital Center, Covilhã, Portugal.
General Surgery Department - Baixo Alentejo Local Health Unit, Beja, Portugal.
Port J Card Thorac Vasc Surg. 2022 Jan 4;28(4):59-62. doi: 10.48729/pjctvs.227.
Phlegmasia cerulea dolens is a potentially life-threatening complication of deep venous thrombosis, causing marked swelling and sudden severe pain in the limb, associated with cyanosis, edema and compartment syndrome that together compromise arterial supply. There is no consensus on its treatment.
A 36-year-old woman, with a history of cosmetic surgery 8 days before admission (abdominal liposuction), was admitted to the emergency department with edema, cyanosis, severe pain, decreased temperature and tenderness of the left lower limb. At physical exam, no distal pulses on the left lower limb were found. Angio-CT was performed, showing occlusion of left femoral vein, external and common iliac veins. The patient started treatment with enoxaparin (80 mg, subcutaneous, bid) and percutaneous mechanical thrombectomy (PMT) of the left iliac vein sector was performed, followed by balloon angioplasty and stenting of the left iliac vein sector. It was also deployed a temporary filter in the inferior vena cava. Thrombophilic workup was negative. The patient presented thorough clinical remission after the procedure (Villalta score 0). Two years after surgery, the patient is asymptomatic, and the Doppler ultrasound is unremarkable concerning morphologic changes throughout the left iliac vein sector.
The treatment of phlegmasia cerulea dolens is challenging due to its severity and poor prognosis. Minimally invasive procedures, such as PMT can be an alternative to open surgery. It can also avoid the use of thrombolytics in patients with relative / absolute contraindications to its use.
青肿性疼痛是深静脉血栓形成的一种潜在危及生命的并发症，导致肢体明显肿胀和突然剧烈疼痛，并伴有发绀、水肿和间隔综合征，共同导致动脉供应受损。目前对此病的治疗尚无共识。
一名 36 岁女性，因美容手术（腹部吸脂术）史 8 天，因左下肢水肿、发绀、剧烈疼痛、温度降低和压痛而就诊于急诊科。体格检查发现左下肢无远端脉搏。行血管 CT 检查，显示左股静脉、外髂静脉和髂总静脉闭塞。患者开始接受依诺肝素（80mg，皮下，bid）治疗，并进行左髂静脉扇形区经皮机械血栓切除术（PMT），随后进行左髂静脉扇形区球囊血管成形术和支架置入术。还在腔静脉内放置了临时滤器。血栓形成倾向检查为阴性。患者在手术后表现出彻底的临床缓解（Villalta 评分 0）。手术后 2 年，患者无症状，左髂静脉扇形区的多普勒超声无形态改变。
青肿性疼痛因其严重程度和预后不良而治疗具有挑战性。微创介入治疗（如 PMT）可作为开放性手术的替代方法。对于存在溶栓治疗相对/绝对禁忌证的患者，也可避免使用溶栓药物。
