# Endovascular Treatment of a Bilateral Phlegmasia Caerulea Dolens in a Two Year Old Child With Inferior Vena Cava Atresia: Case Report and Literature Review

## TL;DR

A two-year-old child with a rare blood clot complication and a blocked inferior vena cava was successfully treated using endovascular techniques.

## Contribution

This case is the first to describe successful endovascular treatment of pediatric phlegmasia caerulea dolens with inferior vena cava atresia.

## Key findings

- Endovascular mechanical thrombectomy and venoplasty successfully treated PCD in a child with IVC atresia.
- The child showed full recovery with no sequelae after 12 months of follow-up.
- Modern endovascular techniques can be effective in treating severe DVT in pediatric patients.

## Abstract

Phlegmasia caerulea dolens (PCD) is a rare and potentially life threatening complication of deep vein thrombosis. It is more commonly reported in adult patients and rarely in the paediatric population, especially in healthy children. This review describes the case of a child with PCD and reviews the few cases of paediatric PCD previously reported in the literature.

A search of the Medline database was performed with the purpose of identifying other similar cases and treatment modalities.

This study describes the case of a child with PCD in the setting of an atretic inferior vena cava, who was successfully treated with endovascular mechanical thrombectomy (Indigo Lightning Penumbra aspiration catheter) and intraluminal recanalisation and venoplasty of the inferior vena cava, with full recovery and no sequelae after 12 months of follow up.

The use of mechanical thrombectomy in the setting of severe acute deep vein thrombosis is well established in adults, but not in children. Moreover, the recanalisation of an atretic inferior vena cava in such a young patient has not been described previously. The clinical outcome of this threatening condition was favourable, confirming that modern endovascular techniques for the venous system may also apply to the paediatric population and help deal with similar situations in this subset of patients.

•Phlegmasia caerulea dolens is a rare DVT complication causing acute limb ischaemia.•Inferior vena cava (IVC) atresia is a rare condition that is often discovered in young adults.•A child with PCD and atretic IVC was successfully treated by thrombectomy and IVC recanalisation.•Endovascular treatment of paediatric PCD with IVC atresia can provide good outcomes.

Phlegmasia caerulea dolens is a rare DVT complication causing acute limb ischaemia.

Inferior vena cava (IVC) atresia is a rare condition that is often discovered in young adults.

A child with PCD and atretic IVC was successfully treated by thrombectomy and IVC recanalisation.

Endovascular treatment of paediatric PCD with IVC atresia can provide good outcomes.