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Phlegmasia cerulea dolens after coronary artery bypass surgery: what should we know.

Lee KH, Park HS, Yie K - Korean J Thorac Cardiovasc Surg (2014)

Bottom Line: Phlegmasia cerulea dolens (PCD) is one of the most critical disorders of acute deep vein thrombosis in that it can cause permanent disability secondary to the compartment syndrome.Although several etiological factors have been proposed, PCD after coronary artery bypass surgery is extremely rare and its definitive pathophysiology is still under debate.Early recognition and decompression of PCD are crucial for saving the affected limbs.

View Article: PubMed Central - PubMed

Affiliation: Department of Thoracic and Cardiovascular Surgery, Korea University Anam Hospital, Korea.

ABSTRACT
Phlegmasia cerulea dolens (PCD) is one of the most critical disorders of acute deep vein thrombosis in that it can cause permanent disability secondary to the compartment syndrome. Although several etiological factors have been proposed, PCD after coronary artery bypass surgery is extremely rare and its definitive pathophysiology is still under debate. We herein present a case of PCD that resulted in the compartment syndrome after coronary artery bypass surgery. Early recognition and decompression of PCD are crucial for saving the affected limbs.

No MeSH data available.


Related in: MedlinePlus

Compartment syndrome after greater saphenous vein harvesting for coronary artery bypass surgery. Photo was taken on the 10 days after faciotomy. Note the muscular necrosis and tissue edema.
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Figure 1: Compartment syndrome after greater saphenous vein harvesting for coronary artery bypass surgery. Photo was taken on the 10 days after faciotomy. Note the muscular necrosis and tissue edema.

Mentions: On the first postoperative day, the patient complained of severe left calf pain immediately after extubation. His left leg was markedly swollen, violet in color, tender, and warm up to the knee. Normal Doppler sounds were identified in the dorsalis pedis artery, lateral malleolar artery, and femoral vein. However, the venous flow below the popliteal vein was obscured in the color Doppler ultrasonography, and the patient's left foot was almost paralyzed. A decreased platelet count (85,000/µL) and an increased D-dimer level (355 µg/L) were noted. Because it was believed that anticoagulation therapy and infrapopliteal thrombectomy would be ineffective at that time, a prompt four-part fasciotomy was performed to prevent irreversible neurological and muscle damage. Unfortunately, despite all of our efforts, the patient's swollen muscles became infected with Acinetobacter baumannii after 1 week (Figs. 1, 2). A delayed skin graft was required after repeated aggressive debridement. The foot drop did not recover, and the patient was discharged 5 months postoperatively with a disability.


Phlegmasia cerulea dolens after coronary artery bypass surgery: what should we know.

Lee KH, Park HS, Yie K - Korean J Thorac Cardiovasc Surg (2014)

Compartment syndrome after greater saphenous vein harvesting for coronary artery bypass surgery. Photo was taken on the 10 days after faciotomy. Note the muscular necrosis and tissue edema.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3928263&req=5

Figure 1: Compartment syndrome after greater saphenous vein harvesting for coronary artery bypass surgery. Photo was taken on the 10 days after faciotomy. Note the muscular necrosis and tissue edema.
Mentions: On the first postoperative day, the patient complained of severe left calf pain immediately after extubation. His left leg was markedly swollen, violet in color, tender, and warm up to the knee. Normal Doppler sounds were identified in the dorsalis pedis artery, lateral malleolar artery, and femoral vein. However, the venous flow below the popliteal vein was obscured in the color Doppler ultrasonography, and the patient's left foot was almost paralyzed. A decreased platelet count (85,000/µL) and an increased D-dimer level (355 µg/L) were noted. Because it was believed that anticoagulation therapy and infrapopliteal thrombectomy would be ineffective at that time, a prompt four-part fasciotomy was performed to prevent irreversible neurological and muscle damage. Unfortunately, despite all of our efforts, the patient's swollen muscles became infected with Acinetobacter baumannii after 1 week (Figs. 1, 2). A delayed skin graft was required after repeated aggressive debridement. The foot drop did not recover, and the patient was discharged 5 months postoperatively with a disability.

Bottom Line: Phlegmasia cerulea dolens (PCD) is one of the most critical disorders of acute deep vein thrombosis in that it can cause permanent disability secondary to the compartment syndrome.Although several etiological factors have been proposed, PCD after coronary artery bypass surgery is extremely rare and its definitive pathophysiology is still under debate.Early recognition and decompression of PCD are crucial for saving the affected limbs.

View Article: PubMed Central - PubMed

Affiliation: Department of Thoracic and Cardiovascular Surgery, Korea University Anam Hospital, Korea.

ABSTRACT
Phlegmasia cerulea dolens (PCD) is one of the most critical disorders of acute deep vein thrombosis in that it can cause permanent disability secondary to the compartment syndrome. Although several etiological factors have been proposed, PCD after coronary artery bypass surgery is extremely rare and its definitive pathophysiology is still under debate. We herein present a case of PCD that resulted in the compartment syndrome after coronary artery bypass surgery. Early recognition and decompression of PCD are crucial for saving the affected limbs.

No MeSH data available.


Related in: MedlinePlus