PMC7652628_01
Left lower extremity: (a) at the time of diagnosis of phlegmasia cerulea dolens; (b) 16 hours after thrombectomy; (c) at one-month follow-up.
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Within three hours postoperation, the patient was still lethargic and did not complain of pain; however, his left lower extremity was noted to be swollen and cool to the touch from the thigh down with a mottled skin appearance (Figure 1(a)). Sixteen hours postintervention, the leg swelling and discoloration almost completely resolved (Figure 1(b)). At 1-month follow-up, the left leg had completely returned to baseline appearance without any evidence of edema or discoloration (Figure 1(c)).
Computed tomography angiography showing the lack of arterial blood flow in the left superficial femoral and proximal popliteal arteries.
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As a result, a computed tomography arteriography (CTA) of the abdominal aorta with bilateral runoff was done and showed the previously placed stent extending from the left superficial femoral artery to the proximal popliteal artery with absent filling consistent with vascular occlusion (Figure 2).
Venography of the lower extremity: (a) absence of blood flow due to thrombus; (b) restoration of blood flow after thrombectomy; (c) large amount of thrombus extracted using the ClotTriever system.
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In the catheterization lab, venography of the inferior vena cava (IVC) via left popliteal vein access revealed extensive and occlusive thrombosis of the iliac, femoral, and popliteal veins (Figure 3(a)). The ClotTriever thrombectomy catheter was then introduced, and six device passes were made extending from the iliac vein back into the popliteal vein with extraction of a significant amount of thrombus (Figure 3(c)). Immediate postintervention venography revealed restoration of the venous flow (Figure 3(b)), and ultrasound Doppler detected a strong popliteal arterial flow.
Intravascular ultrasound (IVUS) of the iliac vein: (a) precompression; (b) site of compression; (c) postcompression.
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An intravascular ultrasound detected compression strictures of the common iliac and femoral veins (Figure 4), and percutaneous transluminal angioplasty was performed (Figure 5).
Fluoroscopy showing percutaneous transluminal angioplasty of the left iliac vein.
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An intravascular ultrasound detected compression strictures of the common iliac and femoral veins (Figure 4), and percutaneous transluminal angioplasty was performed (Figure 5).