Phiegmasia cerulea dolens. Diagnostics and therapy

Background. A total occlusion of the venous outflow is called phlegmasia cerulea dolens (PCD). A massive backlog of venous blood results in a substantial increase in tissue pressure. This often causes compartment syndrome with a subsequent decrease in arterial blood flow in the affected extremity or even venous gangrene. Due to the relatively small ischemic tolerance of the tissue there are different prerequisites for the diagnostics and therapy of PCD compared to incomplete deep vein thrombosis. Objective. What are the therapy options for complete occlusion of the venous outflow? Results. Conservative therapy of PCD is not a recommended option because of the high mortality rate. For this reason the diagnostics and therapeutic steps have to be carried out without any time delay. The current gold standard in PCD therapy is the operative recanalization of venous outflow. Interventional treatment of PCD is a therapeutic option in the initial stages of the disease or in the absence of operative therapy options. In most cases there is no need to perform a fasciotomy after successful recanalization. Conclusion. The number of available literature sources are limited due to the rarity of PCD and mostly consist of case reports.