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Cardiovasc Intervent Radiol · Oct 2012
Case ReportsPhlegmasia caerulea dolens in a patient with an inferior vena cava filter: treatment of massive iliocaval thrombosis using local intravenous catheter-directed thrombolysis.
- Daniel Cookson and Stuart Caldwell.
- Department of Radiology, Middlemore Hospital, Auckland, New Zealand. danielthomascookson@yahoo.co.uk
- Cardiovasc Intervent Radiol. 2012 Oct 1; 35 (5): 1226-30.
AbstractPhlegmasia caerulea dolens (PCD) is a potentially disastrous complication of inferior vena cava filter insertion, and its optimum management has not been clearly established. We present a case report of a patient with pulmonary embolism and acute adrenal haemorrhage who developed PCD secondary to massive iliocaval thrombosis after insertion of a Cook Celect removable filter. Local intravenous catheter-directed thrombolysis (CDT), followed by systemic anticoagulation, achieved limb salvage and virtual resolution of symptoms at 3 months without complications. CDT can be a successful primary treatment of filter-associated PCD and can be safe in selected patients with acute nontraumatic haemorrhage. Systemic anticoagulation may subsequently restore complete venous patency and may therefore be a useful approach to postthrombolysis management of residual iliocaval thrombus when filter removal is indicated.
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