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Lower Limb Venous Thromboembolism
Published in James Michael Forsyth, How to Be a Safe Consultant Vascular Surgeon from Day One, 2023
What is your working diagnosis?“I suspect that this patient has a right-sided ileofemoral DVT. This is likely secondary to starting the combined oral contraceptive pill one week ago, which is a known risk factor. At the moment I am not overtly concerned that the patient has any limb threat. Given the pigment of her skin it is difficult to authoritatively say that she does not have phlegmasia alba dolens or phlegmasia cerula dolens, but pragmatically I do not think she does.”
Venous Ultrasound
Published in John McCafferty, James M Forsyth, Point of Care Ultrasound Made Easy, 2020
If the proximal deep veins are obstructed, this can present with a very swollen thigh as well as the calf (i.e., an ileofemoral DVT). Phlegmasia alba dolens is the swollen ‘white’ painful limb that is found in patients with ileofemoral DVT. These patients generally have a more limited occlusion of the iliac veins. Phlegmasia cerulea dolens is the swollen ‘blue’ painful limb that is seen in patients with a more significant ileofemoral DVT with more extensive thrombosis. In these patients, the venous hypertension is more pronounced with elevated compartment pressures leading to a greater degree of pain and discomfort. The blue cyanotic discolouration is caused by a stagnation of venous blood in the dermal and subdermal venous plexuses. At the most severe end of the spectrum is venous gangrene, which represents soft tissue necrosis in a limb with a large burden proximal DVT. This presentation usually represents a progression from phlegmasia alba dolens through phlegmasia cerulea dolens. The venous gangrene itself ultimately results from small vein and microvascular thrombosis. Venous gangrene in these contexts is often associated with malignancy and other serious conditions like heparin-induced thrombocytopenia, disseminated intravascular coagulation, acute liver dysfunction, and sepsis. Ileofemoral DVT should therefore be taken seriously and early consultation with vascular surgery is recommended.
Thromboembolism and Cancer
Published in Hau C. Kwaan, Meyer M. Samama, Clinical Thrombosis, 2019
Benjamin Esparaz, Merrill S. Kies, Hau C. Kwaan
Gentlemen: Those following my clinical work have surely noticed that there is a frequency of special diseases which attract attention due to the numerous circumstances in which they are observed. I want to talk about phlegmasia alba dolens. You do remember that we have studied together the white painful edema not only in women with recent parturition but more often in patients of both sexes affected with pulmonary phthisis or internal cancerous tumors. This is a rare example of generalized intravenous coagulation in the four limbs. What are the conditions where blood acquired this tendency of spontaneous coagulation? You know gentlemen, in cachetic states in general, tuberculosis and cancer cachexia in particular, the blood is modified…
Prevention, treatment, and risk factors of deep vein thrombosis in critically ill patients in Zhejiang province, China: a multicenter, prospective, observational study
Published in Annals of Medicine, 2021
Li Li, Jia Zhou, Liquan Huang, Junhai Zhen, Lina Yao, Lingen Xu, Weimin Zhang, Gensheng Zhang, Qijiang Chen, Bihuan Cheng, Shijin Gong, Guolong Cai, Ronglin Jiang, Jing Yan
Deep vein thrombosis (DVT) is caused by a blood clot obstructing blood flow in the deep venous system, most commonly occurring in the lower limbs [1]. It can be provoked by factors, such as recent surgery or trauma, hospitalisation with prolonged bed rest, or the use of oral contraceptives [1]. An unprovoked DVT may be idiopathic or inherited or from acquired hypercoagulable states, such as cancer and pregnancy [1]. The estimated annual worldwide incidence of venous thromboembolism (VTE) is 10 million [1–3]. DVT is observed in about 0.51% of hospitalised patients [4], 0.8%–8% of patients with cancer [5–7], 0.8%–9.6% of patients with surgery [8–10], and 5%–31% of intensive care unit (ICU) patients [11,12], and the incidence increases with age [1–3]. A study based on a large healthcare database in China revealed an annual incidence of DVT of 30.0 per 100,000 populations [13]. Pulmonary embolism, post-thrombotic syndrome, phlegmasia cerulea dolens, phlegmasia alba dolens, and paradoxical embolism leading to cryptogenic embolic stroke are possible complications of DVT [14–17]. In addition, DVT is associated with an increased risk of mortality [18–20].