Management of Bilateral Phlegmasia Cerulea Dolens in a Patient with Subacute Splenic Laceration

Abstract

Phlegmasia cerulea dolens (PCD) is a rare but limb-threatening complication of deep vein thrombosis. We report a case of a 76-year-old man with recent splenic trauma and inferior vena cava (IVC) filter placement, who developed bilateral lower extremity PCD. Utilizing an endoluminal approach, the patient underwent mechanical thrombectomy and thrombolysis through bilateral infusion catheters placed antegrade from bothpopliteal veins. Clot lysis and return of palpable pedal pulses occurred within 24 hours. We demonstrate that the endoluminal management of this disease may be cautiously applied to the trauma patient, and that the judicious use of thrombolytic therapy can be beneficial even in the patient with a high potential for hemorrhage.