title: Surgical venous thrombectomy for phlegmasia cerulea dolens and venous gangrene of the lower extremities.
abstract: OBJECTIVE
  Phlegmasia cerulea dolens (PCD) and venous gangrene are limb and life-threatening conditions of iliofemoral acute deep vein thrombosis (DVT).
  
  
  METHODS
  The authors retrospectively evaluated surgical management of 15 patients from 125 patients with acute iliofemoral DVT (6 PCD and 9 venous gangrene) between January 1991 and August 2002 with long-term follow-up.
  
  
  RESULTS
  All of our 15 patients underwent surgery within 10 days of the onset of symptoms. Six patient with impending gangrene and failure for initial management with bed rest, extremity elevation, fluid resuscitation, and systemic anticoagulation for six to 12 hours underwent iliofemoral venous thrombectomy and distal arteriovenous fistula (AVF) can preserve limbs. In nine patients with venous gangrene that underwent iliofemoral thrombectomy below knee had transmetatarsal amputation done after decreasing leg edema. All patients underwent caval filter insertion before venous thrombectomy. There was no pulmonary embolism (PE) or immediate mortality. Anticoagulation treatment was given for at least six months. The distal arteriovenous fistula was closed as a secondary operation six weeks after initial operation. On the follow-up, 10-year period, seven patients died from the advanced carcinomas 7, 9, 9, 12, 14, 18, and 20 months after an operation. The remaining eight patients have regularly followed-up over 120 months. Three patients (37.5%) had recurrence of DVT; the rate of recanalization in common iliac veins on duplex scan was 100%. Three patients (37.5%) developed reflux in at least one deep venous segment without signs and symptoms of postphlebitic syndrome.
  
  
  CONCLUSIONS
  Surgical venous thrombectomy with distal AVF are safe method and should be reserved to treat PCD and venous gangrene patients with contraindications to thrombolysis or in condition that thrombolytic therapy is not available. There is no postphlebitic syndrome on the long-term follow-up (> 120 months) of all surviving patients.
authors.affiliation: Division of Vascular and Endovascular Surgery, Department of Surgery, Chiang Mai University Hospital, Chiang Mai, Thailand. klaohape@gmail.com
authors.forename: Kamphol
authors.initials: K
authors.lastname: Laohapensang
authors.affiliation: Division of Vascular and Endovascular Surgery, Department of Surgery, Chiang Mai University Hospital, Chiang Mai, Thailand.
authors.forename: Sayam
authors.initials: S
authors.lastname: Hanpipat
authors.affiliation: Division of Vascular and Endovascular Surgery, Department of Surgery, Chiang Mai University Hospital, Chiang Mai, Thailand.
authors.forename: Supapong
authors.initials: S
authors.lastname: Aworn
authors.affiliation: Division of Vascular and Endovascular Surgery, Department of Surgery, Chiang Mai University Hospital, Chiang Mai, Thailand.
authors.forename: Saranat
authors.initials: S
authors.lastname: Orrapin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005734:Gangrene; D006801:Humans; D007866:Leg / Q000098:blood supply / Q000473:pathology; D008297:Male; D008875:Middle Aged; D017131:Thrombectomy / Q000379:methods; D016306:Vena Cava Filters; D020246:Venous Thrombosis / Q000601:surgery*