Endovascular treatment of upper limb phlegmasia cerulea dolens in a hemodialysis patient.

Phlegmasia cerulea dolens (PCD) is a rare but limb-threatening complication of deep vein thrombosis. A 72-year-old hemodialysis male patient presented with upper limb PCD. The patient underwent hemodialysis via a permanent hemodialysis central venous catheter (HD-CVC) while a new brachial-cephalic AVF was created 1 month ago. Computed tomography revealed extensive thrombosis of right subclavian and brachiocephalic vein. The HD-CVC was removed and patient was treated with anticoagulation therapy. However, his clinical condition was worsening and he was transferred to IR department. The patient underwent successful percutaneous pharmacomechanical thrombectomy (PMT) of the right subclavian and brachiocephalic vein followed by percutaneous angioplasty (PTA) with significant flow restoration and no signs of pulmonary embolization. PCD may also be developed in hemodialysis patients with well-functioned AVF. Effective and rapid revascularization is important to prevent serious complications such as venous gangrene and limb ischemia. Endovascular treatment with PMT and PTA can be a limb-saving procedure for rapid recanalization in patients with PCD.