Abstract Phlegmasia cerula dolens is a grave complication of deep thrombophlebitis, characterized by a sudden massive venous occlusion which simulates arterial embolism in its effects and seriously endangers both the patient's life and the affected limb. In the last decade, the British and American literature indicate a growing awareness that the condition is not so rare as had been thought.17,18 However, the differential diagnosis is difficult and entails dismissing the possibility of arterial exploration early in the course, and later, decision to avoid premature amputation. Moreover, the preferred conservative management may require many months, and the course is fraught with dangers of further complications such as pulmonary embolism, infection, and psychological disturbance. It is the aim of this paper, by presenting a case and briefly reviewing the clinical features, to draw attention to this entity and the value of patient conservative medical and surgical management. Historical Development As early as References 1. Fabricus Hildanus, G.: De gangraena et sphacelo , Cologne, 1593. 2. Cruveilhier, J.: Traité d'anatomie pathologique générale , Paris, J. B. Bailliére et fils, 1862,Vol. 4. 3. Buerger, L.: The Circulatory Disturbances of the Extremities , Philadelphia, W. B. Saunders Company, 1924. 4. Fontaine, R., and Souza-Pereira, A.: Oblitérations et résections veineuses expérimentales: Contribution à l'étude de la circulation collatérale veineuse , Rev. chir. Paris 75:161, 1937. 5. Audier, M., and Haimovici, H.: Les gangrènes des membres d'origine veineuse , Presse méd. 46:1403, 1938. 6. DeBakey, M. E.; Burch, G. E., and Ochsner, A.: Effect of Chemical Irritation of a Venous Segment on Peripheral Pulse Volume , Proc. Soc. Exper. Biol. & Med. 41:585, 1939. 7. Ray, C. T., and Burch, G.: Vascular Responses in Man to Ligation of the Inferior Vena Cava , Arch. Int. Med. 80:587, 1947. 8. DeBakey, M. E., and Ochsner, A.: Gangrene Associated with Thrombophlebitis, Phlegmasia Cerulea Dolens: Case Reports and Review of Literature , Surgery 26:16, 1949. 9. Haimovici, H.: Gangrene of the Extremities of Venous Origin: Review of Literature with Case Reports , Circulation 1:225, 1950. 10. Veal, J. R.; Dugan, J. T.; Jamison, W. L., and Bauersfield, R. S.: Acute Massive Venous Occlusion of the Lower Extremities , Surgery 29: 355, 1951. 11. Ellis, J. T., and Windham, S. W.: Acute Massive Venous Occlusion in the Lower Extremity , Ann. Surg. 135:262, 1952. 12. Halligan, E. J.; Costello, J. L., and Lewis, T. F.: Acute Massive Venous Occlusion of the Lower Extremity , Ann. Surg. 137:543, 1953. 13. Martin, P.: Phlegmasia Cerulea Dolens , Brit. M.J. 2:1351, 1953. 14. Mahorner, H.: A New Method of Management of Thrombosis of the Deep Veins of the Extremities: Thrombectomy, Restoration of the Lumen and Heparinization , Am. Surgeon 20:487, 1954. 15. Manheimer, L. H., and Levin, L. M.: Phlegmasia Cerulea Dolens: Report of 2 Cases and Discussions of Pathogenesis , Angiology 5: 472, 1954. 16. Rasmussen, J. A.; Potter, S. E., and Best, R. R.: The Management of Acute Massive Venous Occlusion , Surgery 40:387, 1956. 17. Catchpole, B. N.: Massive Thrombophlebitis , Lancet 1:343, 1957. 18. Edwards, W. S.: Observations on the Pathogenesis and Management of Massive Venous Occlusion , Surgery 43:153. 1958.
Archives of Internal Medicine – American Medical Association
Published: Nov 1, 1960