Endoluminal recanalization in a patient with phlegmasia cerulea dolens using a multimodality approach-a case report.
Phlegmasia cerulea dolens is a limb-threatening form of deep venous thrombosis and should be treated aggressively. The authors report a patient who presented with iliocaval and femoral deep venous thrombosis and posed an additional therapeutic challenge based on a recent history of heparin-induced thrombocytopenia. Catheter-directed pharmacologic thrombolysis and balloon venoplasty were applied in treatment. The direct thrombin inhibitor argatroban was used in place of heparin for concurrent anticoagulation. This multimodality endovascular approach (chemical and mechanical interventions) was successful in relieving the venous occlusion and salvaging the limb, while maintaining appropriate treatment for heparin-induced thrombocytopenia.
Lin
Stephanie C
SC
Department of Vascular Surgery, New York Presbyterian Hospital, Cornell University, Weill Medical School and Columbia University, College of Physicians and Surgeons, New York, NY 10021, USA.
Mousa
Albeir
A
Bernheim
Joshua
J
Dayal
Rajeev
R
Henderson
Peter
P
Hollenbeck
Scott
S
Kent
K Craig
KC
Faries
Peter L
PL
D000925:Anticoagulants / Q000627:therapeutic use; D002404:Catheterization; D004359:Drug Therapy, Combination; D005260:Female; D005268:Femoral Vein; D006801:Humans; D007084:Iliac Vein; D007866:Leg / Q000098:blood supply; D023821:Limb Salvage / Q000379:methods; D008875:Middle Aged; D010960:Plasminogen Activators / Q000627:therapeutic use; D011655:Pulmonary Embolism / Q000628:therapy; D015912:Thrombolytic Therapy / Q000295:instrumentation / Q000379:methods*; D016306:Vena Cava Filters; D014684:Venae Cavae; D020246:Venous Thrombosis / Q000628:therapy*
D000925:Anticoagulants; D010960:Plasminogen Activators