PMC5331162_01
Fall of platelets (PLT) after LMWH discontinued, with a sudden rise at reintroduction; supratherapeutic INR associated with low platelets at the phegmasia onset (day 11).
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A left DVT (LET class III) was established, and the patient started on 0.6 mL of daily nadroparin, an NSAID, and elastic bandage with moderate compression applied over the left lower limb (Fig. 1).
Phlegmasia cerulea dolens onset, asymmetric severe limb edema with cyanosis of foot and leg.
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Four days afterwards, a sudden painful cyanosis of foot and ankle developed, with Doppler probe detectable pulse on posterior tibial and dorsalis pedis arteries (Fig. 2).
Left inguinal exposure of common femoral vein and the thrombectomy-specimen of unorganized thrombotic masses.
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By groin approach, using Fogarty thrombembolectomy catheters 5F, 8F a significant quantity of unorganized thrombotic masses were retrogradely extracted from the external iliac vein, common femoral vein, antegradely from the greater saphenous vein, and by means of infrapopliteal access - retrogradely from the superficial femoral vein (Fig. 3).
Post-operative course, 35th POD, before skin grafting.
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Over the next 10 days, wound debridement and necrectomy was repeatedly performed, followed by skin grafting (Fig. 4).