RT Book, Section
A1 Tsekouras, Nikos
A1 Comerota, Anthony J.
A2 Dean, Steven M.
A2 Satiani, Bhagwan
A2 Abraham, William T.
SR Print(0)
ID 1105291496
T1 PHLEGMASIA CERULEA DOLENS
T2 Color Atlas and Synopsis of Vascular Diseases
YR 2015
FD 2015
PB McGraw-Hill Medical
PP New York, NY
SN 9780071749541
LK accesssurgery.mhmedical.com/content.aspx?aid=1105291496
RD 2024/04/25
AB A  65-year-old  gentleman  was  referred  with  left  lower  extremity  phlegmasia  cerulea  dolens  (PCD)  1  day  following  an  exploratory  laparotomy.  Postoperatively  he  developed  painful  diffuse  swelling  of  his  left  lower  extremity  with  bluish  discoloration  (Figure  58-1).  On  arrival,  he  underwent  a  venous  duplex  that  demonstrated  thrombosis  of  his  tibial,  popliteal,  femoral,  common  femoral,  and  external  iliac  veins.  Computed  tomographic  angiography  (CTA)  scan  with  contrast  of  the  head,  chest,  abdomen,  and  pelvis  was  performed.  The  patient  had  bilateral,  asymptomatic  pulmonary  emboli  (Figure  58-2),  and  mediastinal,  retroperitoneal,  and  pelvic  lymphadenopathy  (Figure  58-3),  which  subsequently  proved  to  be  lymphoma.  The  patient  was  brought  to  the  interventional  radiology  suite  and  an  ascending  phlebogram  was  performed.  The  phlebogram  confirmed  extensive  venous  thrombosis  from  the  calf  veins  through  the  iliac  veins  (Figure  58-4).  With  the  patient  in  the  supine  position  and  under  ultrasound  guidance,  access  to  the  posterior  tibial  vein  was  obtained  through  which  an  EKOS  Lysus  (EKOS  Corp,  Bothell,  WA)  catheter  was  positioned.  The  patient  was  then  placed  in  the  prone  position.  Under  ultrasound  guidance,  the  popliteal  vein  was  entered  and  a  sheath  advanced  through  which  a  Trellis  (Covidien,  Mansfield,  MA)  catheter  was  used  (Figure  58-5).