title: Phlegmasia caerulea dolens in a patient with an inferior vena cava filter: treatment of massive iliocaval thrombosis using local intravenous catheter-directed thrombolysis.
abstract: 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.
authors.affiliation: Department of Radiology, Middlemore Hospital, Auckland, New Zealand. danielthomascookson@yahoo.co.uk
authors.forename: Daniel
authors.initials: D
authors.lastname: Cookson
authors.forename: Stuart
authors.initials: S
authors.lastname: Caldwell
mesh_terms: D000307:Adrenal Gland Diseases / Q000000981:diagnostic imaging; D000368:Aged; D000792:Angiography; D000925:Anticoagulants / Q000627:therapeutic use; D003287:Contrast Media; D003937:Diagnosis, Differential; D006470:Hemorrhage / Q000000981:diagnostic imaging; D006801:Humans; D007084:Iliac Vein / Q000000981:diagnostic imaging; D007866:Leg / Q000098:blood supply; D008297:Male; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging* / Q000628:therapy*; D015912:Thrombolytic Therapy; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D014057:Tomography, X-Ray Computed; D014654:Vascular Patency; D016306:Vena Cava Filters / Q000009:adverse effects*
chemical_list: D000925:Anticoagulants; D003287:Contrast Media