Kritieke ischemie van het been door twee bijzondere vormen van diepveneuze trombose

Three patients, two women of 46 and 33 years, and a man of 64 years were referred to the emergency department with extremely painful, swollen and discoloured lower extremities with signs of critical ischaemia. In all 3 patients the symptoms were progressive. Duplex ultrasound and CT showed extensive thrombosis of the superficial and deep veins of the affected extremity and the diagnosis phlegmasia caerulea dolens was established. Treatment in all patients consisted of surgical thrombectomy, in one patient preceded by catheter-guided thrombolysis. Two patients survived but one of these suffered a post-thrombotic syndrome. The third patient died 17 days after surgery. Phlegmasia caerulea dolens is distinguished from regular deep vein thrombosis by extreme pain and fast progression resulting in ischaemia of the affected limb. Besides the deep vein system, the superficial veins are also affected by the thrombosis. In phlegmasia alba dolens only the deep vein system is affected. When left untreated phlegmasia results in high morbidity and mortality. Due to its progressive course quick diagnosis and treatment are essential when phlegmasia is suspected.