Phlegmasia cerulea dolens in a patient with partial inferior vena cava interruption treated with mechanical thrombectomy

TL;DR

A 70-year-old woman with a rare venous condition was successfully treated with mechanical thrombectomy for a severe leg clot.

Contribution

This case highlights the successful use of mechanical thrombectomy in patients with complex venous anatomy and partial inferior vena cava interruption.

Findings

The patient had an occlusive left pelvic DVT and a partial inferior vena cava interruption via a Moretz clip.

Mechanical thrombectomy and iliocaval reconstruction effectively treated the condition.

Endovascular techniques may be optimal for patients with altered venous anatomy and DVT.

Abstract

Phlegmasia cerulea dolens is a rare condition associated with deep vein thrombosis (DVT). Inferior vena cava clips are even more rarely seen devices historically placed in the context of DVT. In this case, a 70-year-old woman with a distant history of DVT presented with acute onset left calf pain, swelling, and discoloration. The patient was discovered to have decreased arterial pulses on physical examination, but no evidence of acute arterial occlusion. Upon further workup, an occlusive left pelvic DVT as well as partial inferior vena cava interruption via a Moretz clip was discovered. The patient was treated with mechanical thrombectomy and iliocaval reconstruction. Patients with complex and altered venous anatomy may be prone to complications of DVT. They remain candidates for endovascular thrombectomy and stenting. In fact, these techniques may represent the most effective and efficient treatments in these circumstances.

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