Phlegmasia Cerulea Dolens: Rare Complication of Vena Cava Filter Placement in Man With Paraplegia

J Spinal Cord Med, 2008 · DOI: · Published: January 1, 2008

Spinal Cord Injury Cardiovascular Science Rehabilitation

Simple Explanation

This case report describes a rare and serious complication, phlegmasia cerulea dolens (PCD), following the placement of an inferior vena cava (IVC) filter in a man with paraplegia. The patient, who had a spinal cord injury, developed deep vein thrombosis (DVT). An IVC filter was placed to prevent pulmonary embolism. However, he subsequently developed PCD, a condition involving extensive DVT causing severe leg pain and other complications. Despite medical interventions, the patient's condition worsened, leading to multi-organ failure and death. The autopsy confirmed extensive thrombosis and pulmonary emboli, consistent with PCD.

Study Duration

Not specified

Participants

A 48-year-old man with T11 paraplegia

Evidence Level

Case report

Key Findings

1
IVC filters, while intended to prevent pulmonary embolism, do not address the underlying thrombotic process and can potentially contribute to thrombosis.
2
Phlegmasia cerulea dolens is a rare but potentially fatal complication of iliofemoral thrombosis, characterized by complete venous outflow obstruction, tissue ischemia, and severe symptoms.
3
The case suggests that IVC filters may act as a thrombogenic nidus in patients with spinal cord injury who have a history of DVT.

Research Summary

This case report details a 48-year-old man with paraplegia who developed phlegmasia cerulea dolens (PCD) after the placement of an inferior vena cava (IVC) filter to prevent pulmonary embolism following deep vein thrombosis (DVT). The patient's condition rapidly deteriorated, leading to hypotension, acute renal failure, compartment syndrome, and ultimately death despite aggressive medical intervention including fasciotomies and attempted thrombectomy. The authors conclude that while IVC filters can prevent pulmonary embolism, they do not address the underlying thrombotic process and may, in fact, contribute to thrombosis, especially in high-risk patients with spinal cord injuries and pre-existing DVT.

Practical Implications

Clinical Awareness

Clinicians should be aware of the potential risk of PCD following IVC filter placement, especially in patients with spinal cord injury and a history of DVT.

Careful Patient Selection

Careful consideration should be given to the risks and benefits of IVC filter placement in patients with spinal cord injury, weighing the potential for pulmonary embolism against the risk of thrombotic complications.

Prompt Diagnosis and Treatment

Early recognition and aggressive management of PCD are crucial to improving patient outcomes, including rapid volume replacement, extremity elevation, and consideration of thrombectomy.

Study Limitations

1
Single case report limits generalizability.
2
Unable to determine causality definitively between IVC filter and PCD.
3
Specific details regarding long-term outcomes are limited due to the patient's death.

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