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Case Reports
. 2021;81(3):454-457.

[Phlegmasia cerulea dolens. Treatment with systemic fibrinolysis]

[Article in Spanish]
Sofía Llerena  1 , Damián Piezny  2 , Fernando Ríos  2 , Constanza Arias  2 , Judith Sagardía  2
Affiliations
  • PMID: 34137708
Free article
Case Reports

[Phlegmasia cerulea dolens. Treatment with systemic fibrinolysis]

[Article in Spanish]
Sofía Llerena et al. Medicina (B Aires). 2021.
Free article

Abstract
in English, Spanish

Phlegmasia cerulea dolens (FCD) is a rare complication of deep vein thrombosis. Its cause is unknown. The main predisposing factors for the disease are neoformative processes, hypercoagulable states, congestive heart failure, pregnancy, prolonged immobilization, and surgeries on the affected limb. FCD is characterized by massive edema, severe pain, and cyanosis. The diagnosis is clinical. It is associated in most cases with pulmonary embolism and can lead to loss of the compromised limb if not treated in time. So far there is no consensus on its treatment. In clinical practice the use of anticoagulation with heparin, local thrombolysis, systemic fibrinolysis, surgical thrombectomy, fasciotomy, and inferior vena cava filter are described. In irreversible cases amputation is required. We present the case of a patient with FCD, the treatment performed and the evolution.

La flegmasia cerulea dolens es una complicación rara y poco frecuente de la trombosis venos a profunda. Los principales factores predisponentes son los procesos neoformativos, estados de hipercoagulabilidad, insuficiencia cardíaca congestiva, embarazo, inmovilización prolongada y cirugías. Se caracteriza por edema masivo, dolor intenso y cianosis. Sin tratamiento evoluciona con isquemia, necrosis y amputación del miembro comprometido. No existe consenso en su tratamiento, pero éste debe ser rápido, multidisciplinario y agresivo. La anticoagulación con heparina, la fibrinólisis sistémica, la trombectomía percutánea con fibrinólisis local, la trombectomía quirúrgica, la fasciotomía, la colocación de filtro de vena cava inferior y la amputación son algunos de los tratamientos propuestos.

Keywords: anticoagulation; deep vein thrombosis; phlegmasia cerulea dolens; surgical thrombectomy; thrombolysis; venous gangrene.

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