eMedicine Specialties > Vascular Surgery > Medical Topics

Phlegmasia Alba and Cerulea Dolens: Follow-up

Author: Alan Dardik, MD, PhD, FACS, Associate Professor, Department of Surgery, Section of Vascular Surgery, Yale University School of Medicine
Coauthor(s): Dina Rahhal, MD, Postdoctoral Fellow in Transplant Immunology, Institute for Cellular Therapeutics, University of Louisville
Contributor Information and Disclosures

Updated: Sep 10, 2009

Outcome and Prognosis

Despite all of the therapeutic modalities described above, phlegmasia cerulea dolens (PCD) and venous gangrene still remain life-threatening and limb-threatening conditions with overall mortality rates of 20-40%. Pulmonary embolism (PE) is responsible for 30% of the deaths reported from PCD. Overall, amputation rates of 12-50% have been reported among survivors. The postphlebitic sequelae are apparent in 60-94% of survivors. Strict adherence to the use of long-term compression stockings helps to control chronic edema.

Future and Controversies

Phlegmasia alba dolens, phlegmasia cerulea dolens (PCD), and venous gangrene still remain a challenge to the vascular surgeon. Treatment modalities continue to evolve. Endovascular management may offer hope of successful and more effective management, with less morbidity, than traditional surgery. The role of mechanical thrombectomy, compared with thrombolysis, is unclear. Small numbers of patients and lack of randomized trials preclude clear recommendations.

 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author Timothy Liem, MD, to the development and writing of this article.



More on Phlegmasia Alba and Cerulea Dolens

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Follow-up: Phlegmasia Alba and Cerulea Dolens
Multimedia: Phlegmasia Alba and Cerulea Dolens
References
Further Reading
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References

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Further Reading

Clinical guidelines

Snow V, Qaseem A, Barry P, Hornbake ER, Rodnick JE, Tobolic T, Ireland B, Segal JB, Bass EB, Weiss KB, Green L, Owens DK, American College of Physicians, American Academy of Family Physicians Panel on Deep Venous. Management of venous thromboembolism: a clinical practice guideline from the American College of Physicians and the American Academy of Family Physicians. Ann Intern Med 2007 Feb 6;146(3):204-10. 5

Kearon C, Kahn SR, Agnelli G, Goldhaber S, Raskob GE, Comerota AJ. Antithrombotic therapy for venous thromboembolic disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008 Jun;133(6 Suppl):454S-545S. 6

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Keywords

phlegmasia alba dolens, phlegmasia cerulea dolens, PCD, venous gangrene, surgical thrombectomy, thrombolysis, pulmonary embolism, PE, deep venous thrombosis, DVT, thromboembolism, venous thromboembolism, thrombosis, hypercoagulable syndrome, gastroenteritis, mitral valve stenosis, heart failure, vena caval filter insertion, May-Thurner syndrome, massive thrombosis, ulcerative colitis

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Contributor Information and Disclosures

Author

Alan Dardik, MD, PhD, FACS, Associate Professor, Department of Surgery, Section of Vascular Surgery, Yale University School of Medicine
Alan Dardik, MD, PhD, FACS is a member of the following medical societies: American College of Surgeons, American Society for Cell Biology, Association for Academic Surgery, Association of VA Surgeons, Eastern Vascular Society, Peripheral Vascular Surgery Society, Phi Beta Kappa, Society for Clinical Vascular Surgery, Society for Vascular Medicine and Biology, and Society for Vascular Surgery
Disclosure: Nothing to disclose.

Coauthor(s)

Dina Rahhal, MD, Postdoctoral Fellow in Transplant Immunology, Institute for Cellular Therapeutics, University of Louisville
Disclosure: Nothing to disclose.

Medical Editor

William H Pearce, MD, Chief, Division of Vascular Surgery, Violet and Charles Baldwin Professor of Vascular Surgery, Department of Surgery, Northwestern University School of Medicine
William H Pearce, MD is a member of the following medical societies: American College of Surgeons, American Heart Association, American Surgical Association, Association for Academic Surgery, Association of VA Surgeons, Central Surgical Association, New York Academy of Sciences, Society for Vascular Surgery, Society of Critical Care Medicine, Society of University Surgeons, and Western Surgical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Vincent Lopez Rowe, MD, Assistant Professor of Surgery, Department of Surgery, Division of Vascular Surgery, University of Southern California Medical Center
Vincent Lopez Rowe, MD is a member of the following medical societies: American College of Surgeons, Association for Academic Surgery, Peripheral Vascular Surgery Society, Society for Clinical Vascular Surgery, and Society for Vascular Surgery
Disclosure: Nothing to disclose.

CME Editor

Paolo Zamboni, MD, Professor of Surgery, Chief of Day Surgery Unit, Chair of Vascular Diseases Center, University of Ferrara, Italy
Paolo Zamboni, MD is a member of the following medical societies: American Venous Forum and New York Academy of Sciences
Disclosure: Nothing to disclose.

Chief Editor

William H Pearce, MD, Chief, Division of Vascular Surgery, Violet and Charles Baldwin Professor of Vascular Surgery, Department of Surgery, Northwestern University School of Medicine
William H Pearce, MD is a member of the following medical societies: American College of Surgeons, American Heart Association, American Surgical Association, Association for Academic Surgery, Association of VA Surgeons, Central Surgical Association, New York Academy of Sciences, Society for Vascular Surgery, Society of Critical Care Medicine, Society of University Surgeons, and Western Surgical Association
Disclosure: Nothing to disclose.

 
 
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