| Compartment syndrome in patients with massive venous thrombosis after inferior vena cava filter placement. | |
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MedLine Citation:
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PMID: 21410121 Owner: NLM Status: In-Data-Review |
Abstract/OtherAbstract:
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Massive venous thrombosis, which can occur acutely after inferior vena cava filter placement, has 2 forms: phlegmasia cerulea dolens and phlegmasia alba dolens. In phlegmasia cerulea dolens, complete occlusion of venous outflow occurs. In the milder phlegmasia alba dolens version, collateral venous flow out of the limb remains despite the venous thrombosis. This article presents, to our knowledge, the first 2 cases of massive venous thrombosis (1 phlegmasia cerulea dolens, 1 phlegmasia alba dolens) below inferior vena cava filters occurring after the acute period.Phlegmasia cerulea dolens and phlegmasia alba dolens can present as compartment syndrome. Prompt fasciotomies were performed, but the underlying massive venous thrombosis was not addressed surgically. Phlegmasia cerulea dolens and phlegmasia alba dolens have high morbidity and mortality. The patient with phlegmasia alba dolens required leg and thigh fasciotomies and eventually required an above-knee amputation. The patient with phlegmasia cerulea dolens developed compartment syndrome in the left leg, right leg, and right thigh. Although he underwent decompression of all of these compartments, he died from multiple organ failure.A multidisciplinary approach with the vascular service and the intensivists is required in the treatment of patients with massive venous thrombosis. Treatment goals include preventing additional propagation of the thrombus via anticoagulation, with strong consideration for catheter-directed thrombolysis or thrombectomy and fasciotomies for compartment syndrome. The orthopedic surgeon should keep phlegmasia cerulea dolens and phlegmasia alba dolens in the differential for compartment syndrome, especially in patients who have had a history of acute or chronic inferior vena cava filter placement. |
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Authors:
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Addisu Mesfin; Ying Wei Lum; Tariq Nayfeh; Simon C Mears |
Publication Detail:
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Type: Journal Article Date: 2011-03-11 |
Journal Detail:
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Title: Orthopedics Volume: 34 ISSN: 1938-2367 ISO Abbreviation: Orthopedics Publication Date: 2011 Mar |
Date Detail:
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Created Date: 2011-03-17 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 7806107 Medline TA: Orthopedics Country: United States |
Other Details:
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Languages: eng Pagination: - Citation Subset: IM |
Copyright Information:
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Copyright 2011, SLACK Incorporated. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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