Chia Adrian C K, Yu Junette, Lee Shaun Q W, Ng Nick Z P
Department of Vascular Surgery, Singapore General Hospital, Academia Level, Outram Rd, Singapore.
Duke-NUS Medical School, Singapore General Hospital, Outram Rd 169608, Singapore.
J Surg Case Rep. 2024 Dec 12;2024(12):rjae773. doi: 10.1093/jscr/rjae773. eCollection 2024 Dec.
Phlegmasia cerulea dolens is a rare manifestation of massive deep vein thrombosis with threat to limb and life. A patient with a background of ovarian malignancy in remission and pelvic radiotherapy presented with left lower limb phlegmasia cerulea dolens as a result of extensive acute left lower limb deep vein thrombosis, extending from the popliteal vein to the inferior vena cava. While initial rapid thrombolysis and left iliac vein stenting were successful, she developed significant hemorrhagic complications from her right radial intra-arterial line with compartment syndrome requiring fasciotomy. She subsequently develops contralateral right lower limb deep vein thrombosis with phlegmasia cerulea dolens as a result of the cessation of anticoagulation and 'jailing' of the contralateral right iliac vein. Repeat thrombolysis with a lower dose of thrombolytics was performed, and contralateral iliac vein stenting in 'kissing' configuration was performed successfully. We discuss several lessons learned from this uncommon but important case.
股青肿是严重深静脉血栓形成的一种罕见表现，对肢体和生命构成威胁。一名处于缓解期的卵巢恶性肿瘤患者，曾接受盆腔放疗，因广泛的急性左下肢深静脉血栓形成，从腘静脉延伸至下腔静脉，出现了左下肢股青肿。虽然最初的快速溶栓和左髂静脉支架置入术取得了成功，但她右侧桡动脉置管出现了严重的出血并发症，并伴有骨筋膜室综合征，需要进行筋膜切开术。随后，由于抗凝治疗中断以及对侧右髂静脉“受压”，她对侧右下肢出现了深静脉血栓形成并伴有股青肿。采用较低剂量的溶栓剂进行了重复溶栓，并成功进行了对侧髂静脉“吻接”式支架置入术。我们讨论了从这个不常见但重要的病例中吸取的几点经验教训。
