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Surgical Management of Phlegmasia Cerulea Dolens

Surgical Management of Phlegmasia Cerulea Dolens Abstract Phlegmasia cerulea dolens is a condition in which total or near-total occlusion of the venous outflow tract produces massive edema of the extremity and a characteristic violaceous discoloration of the skin. This extensive venous obstruction ultimately leads to ischemic necrosis. Although the mechanism for this remains obscure, a derangement of capillary function would seem to be implicated. More specifically, a marked decrease in the arteriovenous pressure gradient caused by an absolute increase in the venous pressure would seem to inhibit the arterial inflow critically, while the resultant damage to the capillary walls would interfere with the transfer of oxygen to the tissues. Major occlusion of veins as the cause of gangrene was first described by Fabricus Hildanus in 1593.1 The entity received little attention in the medical literature until 1937, when Fontaine and de Sousa-Pereira2 reported that gangrene resulted in the hind limb of a dog after total References 1. P-Toluenesulfonyl-l-arginine methyl Ester. 2. Fabricus Hildanus: De Gangraena et Sphacelo, Cologne, 1593. 3. Fontaine, R., and de Sousa-Pereira, A.: Oblitérations et résection veineuses expérimentales: Contribution à l'étude de la circulation collatérale veineuse , Rev. Chir. (Paris) 75:161-200, 1937. 4. De Bakey, M. E., and Ochsner, A.: Phlegmasia Cerulea Dolens, Gangrene Associated with Thrombophlebitis: Case Reports and Review of Literature , Surgery 26:16, 1949. 5. Miles, R. M.: Phlegmasia Cerulea Dolens, Successful Treatment by Vena Cava Ligation: Case Report , Surgery 30:718-721, 1951. 6. Osius, E. A.: Acute Massive Venous Occlusion , A.M.A. Arch. Surg. 65:19-30, 1952.Crossref 7. Grant, R. N., and Deddish, M. R.: Phlegmasia Cerulea Dolens and Gangrene , New York J. Med. 52:584-587, 1952. 8. Nunez, A.; Milanes, B.; De La Vaga, L. M.; Vasquez, G., and Inigo, J. R.: Acute Massive Venous Occlusion of the Lower Extremities: Report of 2 Cases , Angiology 3:386-391, 1952.Crossref 9. Turner, D. P. B.: A Case of Phlegmasia Cerulea Dolens , Brit. Med. J. 2::1183-1185, 1952.Crossref 10. Halligan, E. J.; Costello, J. L., and Lewis, T. F.: Acute Massive Venous Occlusion of the Lower Extremity , Ann. Surg. 137:543-547, 1953.Crossref 11. Davies, O. G., and Grimes, O. F.: Pseudoembolic Phlebitis (Phlegmasia Cerulea Dolens): Report of 2 Cases , Amer. J. Surg. 86:480-483, 1953.Crossref 12. Hershey, C. D., and Snyder, R. E.: Thrombophlebitis with Ischemia and Gangrene , Surgery 34:296-302, 1953. 13. Janes, E. C., and Hopmans, C. C.: Case Reports: Phlegmasia Cerulea Dolens , Canad. Med. Ass. J. 68:156-158, 1953. 14. Manheimer, L. H., and Levin, L. M.: Phlegmasia Cerulea Dolens , Angiology 5:472-478, 1954.Crossref 15. Moser, M.; Babin, S. M.; Cotts, G. W., and Prandoní, A. G.: Acute Massive Venous Occlusion: Report of a Case Successfully Treated with Exercise , Ann. Intern. Med. 40:361-368, 1954.Crossref 16. Rasmussen, J. A.; Potter, S. E., and Best, R. R.: The Management of Acute Massive Venous Occlusion , Surgery 40:387, 1956. 17. Mills, E. S., and Bennetts, R. C.: Phlegmasia Cerulea Dolens as a Cause of Gangrene of the Fingers , Canad. Med. Ass. J. 72:917-922, 1955. 18. Haines, R. D.; McMillan, C. D., and Stinson, J C.: Phlegmasia Cerulea Dolens , Texas J. Med. 51:707-610, 1955. 19. Boyd, T. F., and Smith, G.: Gangrene Due to Acute Massive Venous Occlusion of a Limb , Brit. J. Surg. 44:179-182, 1956.Crossref 20. Ellis, J. T., and Windham, S. W.: Acute Massive Venous Occlusion in the Lower Extremity , Ann. Surg. 135:262-266, 1952.Crossref 21. Fountain, J. R., and Taverner, D.: Gangrene of 3 Limbs Resulting from Venous Occlusion , Ann. Intern. Med. 44:549-554, 1956.Crossref 22. Harden, R. N., and Deaton, W. R., Jr.: Phlegmasia Cerulea Dolens: Report of a Case , N. Carolina Med. J. 17:372-373, 1956. 23. Catchpole, B. N.: Massive Thrombophlebitis , Lancet 1:343, 1957.Crossref 24. Rosenberg, N., and Zullo, R. J.: Massive Venous Thrombosis Associated with Incoagulability of the Blood , A.M.A. Arch. Surg. 76:981-985, 1958.Crossref 25. Giles, E. J.: Phlegmasia Cerulea Dolens , Amer. J. Surg. 95:429-433, 1958.Crossref 26. McDonald, S. T.; Person, W. N., and Taylor, L. M.: Thrombophlebitis Cerulea Dolens: Treatment by Passive Exercise with Production of Pulmonary Embolus , A.M.A. Arch. Surg. 80:350-353, 1960.Crossref 27. Meek, J. R., and Maurer, J. J.: Phlegmasia Cerulea Dolens , Amer. J. Surg. 97:104-107, 1959.Crossref 28. Watt, J. H., and Leider, H.: Phlegmasia Cerulea Dolens Complicated by Pulmonary Embolism , New York J. Med. 54:1373-1374, 1959. 29. Moore, R. F., and Scott, G. B. D.: Gangrene of Venous Origin , Brit. J. Surg. 43:591-594, 1956.Crossref 30. Ebel, A.; Kaufman, M., and Ehrenreich, T.: Gangrene of an Extremity Secondary to Venous Thrombosis , A.M.A. Arch. Intern. Med. 90:402-409, 1952.Crossref 31. Edwards, W. B.: Massive Venous Occlusion: Its Pathogenesis and Management , Southern Med. J. 51:1056-1058, 1958.Crossref 32. Boyd, D. P., and Clarke, F. M.: Phlegmasia Cerulea Dolens , Surgery 51:19-25, 1962. 33. Haimovici, H.: Gangrene of the Extremities of Venous Origin: Review of the Literature with Case Reports , Circulation 1:225-240, 1950.Crossref 34. Cywes, S., and Louw, J. H.: Phlegmasia Cerulea Dolens: Successful Treatment by Relieving Fasciotomy , Surgery 51:169-176, 1962. 35. Burch, C. E.; DeBakey, M. E., and Sodeman, W. A.: Effect of Venous Pressure on Volume Pulsation , Proc. Soc. Exper. Biol. Med. 42:858-861, 1939.Crossref 36. Veal, J. R.; Dugan, T. J.; Jamison, W. L., and Bauersfeld, R. S.: Acute Massive Venous Occlusion of the Lower Extremities , Surgery 29: 355-364, 1951 37. Fogarty, T. J.; Cranley, J. J.; Krause, R. J.; Strasser, E. S., and Hafner, C. D.: A New Instrument and Technique for Extraction of Arterial Emboli and Thrombi, to be published. 38. Savage, J. P.: Role of Reflex Spasm in Pathogenesis of Venous Ischemia , Surg. Gynec. Obstet. 113:47-53, 1961. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

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Publisher
American Medical Association
Copyright
Copyright © 1963 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1963.01310080080019
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Abstract

Abstract Phlegmasia cerulea dolens is a condition in which total or near-total occlusion of the venous outflow tract produces massive edema of the extremity and a characteristic violaceous discoloration of the skin. This extensive venous obstruction ultimately leads to ischemic necrosis. Although the mechanism for this remains obscure, a derangement of capillary function would seem to be implicated. More specifically, a marked decrease in the arteriovenous pressure gradient caused by an absolute increase in the venous pressure would seem to inhibit the arterial inflow critically, while the resultant damage to the capillary walls would interfere with the transfer of oxygen to the tissues. Major occlusion of veins as the cause of gangrene was first described by Fabricus Hildanus in 1593.1 The entity received little attention in the medical literature until 1937, when Fontaine and de Sousa-Pereira2 reported that gangrene resulted in the hind limb of a dog after total References 1. P-Toluenesulfonyl-l-arginine methyl Ester. 2. Fabricus Hildanus: De Gangraena et Sphacelo, Cologne, 1593. 3. Fontaine, R., and de Sousa-Pereira, A.: Oblitérations et résection veineuses expérimentales: Contribution à l'étude de la circulation collatérale veineuse , Rev. Chir. (Paris) 75:161-200, 1937. 4. De Bakey, M. E., and Ochsner, A.: Phlegmasia Cerulea Dolens, Gangrene Associated with Thrombophlebitis: Case Reports and Review of Literature , Surgery 26:16, 1949. 5. Miles, R. M.: Phlegmasia Cerulea Dolens, Successful Treatment by Vena Cava Ligation: Case Report , Surgery 30:718-721, 1951. 6. Osius, E. A.: Acute Massive Venous Occlusion , A.M.A. Arch. Surg. 65:19-30, 1952.Crossref 7. Grant, R. N., and Deddish, M. R.: Phlegmasia Cerulea Dolens and Gangrene , New York J. Med. 52:584-587, 1952. 8. Nunez, A.; Milanes, B.; De La Vaga, L. M.; Vasquez, G., and Inigo, J. R.: Acute Massive Venous Occlusion of the Lower Extremities: Report of 2 Cases , Angiology 3:386-391, 1952.Crossref 9. Turner, D. P. B.: A Case of Phlegmasia Cerulea Dolens , Brit. Med. J. 2::1183-1185, 1952.Crossref 10. Halligan, E. J.; Costello, J. L., and Lewis, T. F.: Acute Massive Venous Occlusion of the Lower Extremity , Ann. Surg. 137:543-547, 1953.Crossref 11. Davies, O. G., and Grimes, O. F.: Pseudoembolic Phlebitis (Phlegmasia Cerulea Dolens): Report of 2 Cases , Amer. J. Surg. 86:480-483, 1953.Crossref 12. Hershey, C. D., and Snyder, R. E.: Thrombophlebitis with Ischemia and Gangrene , Surgery 34:296-302, 1953. 13. Janes, E. C., and Hopmans, C. C.: Case Reports: Phlegmasia Cerulea Dolens , Canad. Med. Ass. J. 68:156-158, 1953. 14. Manheimer, L. H., and Levin, L. M.: Phlegmasia Cerulea Dolens , Angiology 5:472-478, 1954.Crossref 15. Moser, M.; Babin, S. M.; Cotts, G. W., and Prandoní, A. G.: Acute Massive Venous Occlusion: Report of a Case Successfully Treated with Exercise , Ann. Intern. Med. 40:361-368, 1954.Crossref 16. Rasmussen, J. A.; Potter, S. E., and Best, R. R.: The Management of Acute Massive Venous Occlusion , Surgery 40:387, 1956. 17. Mills, E. S., and Bennetts, R. C.: Phlegmasia Cerulea Dolens as a Cause of Gangrene of the Fingers , Canad. Med. Ass. J. 72:917-922, 1955. 18. Haines, R. D.; McMillan, C. D., and Stinson, J C.: Phlegmasia Cerulea Dolens , Texas J. Med. 51:707-610, 1955. 19. Boyd, T. F., and Smith, G.: Gangrene Due to Acute Massive Venous Occlusion of a Limb , Brit. J. Surg. 44:179-182, 1956.Crossref 20. Ellis, J. T., and Windham, S. W.: Acute Massive Venous Occlusion in the Lower Extremity , Ann. Surg. 135:262-266, 1952.Crossref 21. Fountain, J. R., and Taverner, D.: Gangrene of 3 Limbs Resulting from Venous Occlusion , Ann. Intern. Med. 44:549-554, 1956.Crossref 22. Harden, R. N., and Deaton, W. R., Jr.: Phlegmasia Cerulea Dolens: Report of a Case , N. Carolina Med. J. 17:372-373, 1956. 23. Catchpole, B. N.: Massive Thrombophlebitis , Lancet 1:343, 1957.Crossref 24. Rosenberg, N., and Zullo, R. J.: Massive Venous Thrombosis Associated with Incoagulability of the Blood , A.M.A. Arch. Surg. 76:981-985, 1958.Crossref 25. Giles, E. J.: Phlegmasia Cerulea Dolens , Amer. J. Surg. 95:429-433, 1958.Crossref 26. McDonald, S. T.; Person, W. N., and Taylor, L. M.: Thrombophlebitis Cerulea Dolens: Treatment by Passive Exercise with Production of Pulmonary Embolus , A.M.A. Arch. Surg. 80:350-353, 1960.Crossref 27. Meek, J. R., and Maurer, J. J.: Phlegmasia Cerulea Dolens , Amer. J. Surg. 97:104-107, 1959.Crossref 28. Watt, J. H., and Leider, H.: Phlegmasia Cerulea Dolens Complicated by Pulmonary Embolism , New York J. Med. 54:1373-1374, 1959. 29. Moore, R. F., and Scott, G. B. D.: Gangrene of Venous Origin , Brit. J. Surg. 43:591-594, 1956.Crossref 30. Ebel, A.; Kaufman, M., and Ehrenreich, T.: Gangrene of an Extremity Secondary to Venous Thrombosis , A.M.A. Arch. Intern. Med. 90:402-409, 1952.Crossref 31. Edwards, W. B.: Massive Venous Occlusion: Its Pathogenesis and Management , Southern Med. J. 51:1056-1058, 1958.Crossref 32. Boyd, D. P., and Clarke, F. M.: Phlegmasia Cerulea Dolens , Surgery 51:19-25, 1962. 33. Haimovici, H.: Gangrene of the Extremities of Venous Origin: Review of the Literature with Case Reports , Circulation 1:225-240, 1950.Crossref 34. Cywes, S., and Louw, J. H.: Phlegmasia Cerulea Dolens: Successful Treatment by Relieving Fasciotomy , Surgery 51:169-176, 1962. 35. Burch, C. E.; DeBakey, M. E., and Sodeman, W. A.: Effect of Venous Pressure on Volume Pulsation , Proc. Soc. Exper. Biol. Med. 42:858-861, 1939.Crossref 36. Veal, J. R.; Dugan, T. J.; Jamison, W. L., and Bauersfeld, R. S.: Acute Massive Venous Occlusion of the Lower Extremities , Surgery 29: 355-364, 1951 37. Fogarty, T. J.; Cranley, J. J.; Krause, R. J.; Strasser, E. S., and Hafner, C. D.: A New Instrument and Technique for Extraction of Arterial Emboli and Thrombi, to be published. 38. Savage, J. P.: Role of Reflex Spasm in Pathogenesis of Venous Ischemia , Surg. Gynec. Obstet. 113:47-53, 1961.

Journal

Archives of SurgeryAmerican Medical Association

Published: Feb 1, 1963

References

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