Phlegmasia cerulea dolens is a rare but catastrophic venous emergency where delayed recognition can mean shock, venous gangrene, amputation, or death. This SAIMSARA evidence map is worth reading because it separates real treatment signals from case-level noise, mapping anticoagulation, thrombolysis, thrombectomy, stenting, fasciotomy, complications, and high-risk contexts across the full clinical spectrum.
Human-verified editorial review
Verified by World ID proof-of-human. This editorial layer was submitted from a SAIMSARA account verified as a unique human.
Abstract: To synthesize the original clinical literature captured for the query “phlegmasia cerulea dolens,” focusing on study characteristics, recurrent disease-defining findings, clinical contexts, management patterns, complications, and implications for diagnosis, treatment selection, and future research. The review uses 121 references and builds its evidence map from 126 original studies with 249 total participants/sample observations (topic-deduplicated ΣN). The synthesized evidence indicates that phlegmasia cerulea dolens is best understood as a time-sensitive venous outflow emergency in which early recognition, prompt anticoagulation, and individualized escalation to clot-reduction therapy are central to limb and life salvage. The most consistent result-level signal supports a role for endovenous debulking and pharmacomechanical strategies, with one 144-patient literature-based retrospective analysis reporting a 70% reduction in amputation/death with endovenous debulking compared with anticoagulation or thrombectomy, although outcomes remained heterogeneous and serious complications including reperfusion injury, acute kidney injury, and fatal embolism were repeatedly reported. Because the underlying evidence is dominated by case-level reports, certainty about comparative effectiveness across thrombolytic, mechanical, surgical, and hybrid pathways remains limited. Future work should prioritize prospective multicenter registries with standardized severity definitions and shared endpoints to benchmark escalation pathways and clarify which patients benefit most from aggressive venous intervention.
Final search date and database lock: 2026-05-13 12:21:42 CEST
Plan: Pro (expanded craft tokens; source: PubMed)
Source: PubMed
Total Abstracts/Papers: 154
Downloaded Abstracts/Papers: 154
Included original and non-original Abstracts/Papers (all): 154
Included original Abstracts/Papers (Vote counting by direction of effect): 126
Reference Index (links used in paper): 121
Total participants/sample observations (topic deduplicated ΣN): 249
Get access to the full paper
Unlock the full evidence map
The full evidence review, including the Introduction, Methods, Results, Discussion, Conclusion, figures, and complete reference index, opens after purchase or sign-in.
The Evidence Object JSON is a separate machine-readable evidence product: a concentrated synthesis of results, topic-level evidence, and discussion across original and non-original studies. It can be directly input into your LLM, agent, or RAG workflow.
[9] Pulseless Electrical Activity Arrest as the First Symptom of Testicular Cancer with Subsequent Phlegmasia Cerulea Dolens. — https://doi.org/10.2478/jccm-2019-0009
[36] Upper extremity phlegmasia cerulea dolens complicating supra vena cava embolism in a cervical cancer patient: case report. — https://doi.org/10.3389/fcvm.2024.1351358
[37] Phlegmasia Cerulea Dolens as an Unusual Presentation of Ruptured Abdominal Aortic Aneurysm into the Inferior Vena Cava. — https://doi.org/10.1016/j.avsg.2016.10.028
[41] Staged Treatment of Phlegmasia Cerulea Dolens in a Patient with Iliac Vein Compression Syndrome and Deep Vein Thrombosis: A Case Report. — https://doi.org/10.5758/vsi.230006
[45] Lessons learned from a case of phlegmasia cerulea dolens treated with thrombolysis and iliac vein stenting. — https://doi.org/10.1093/jscr/rjae773
[46] May-Thurner Syndrome Results in Life-Threatening Condition: Phlegmasia Cerulea Dolens and Rhabdomyolysis. — https://doi.org/10.25270/jic/19.00393
[47] Successful treatment of posttraumatic phlegmasia cerulea dolens by reconstructing the external iliac vein: a case report. — https://doi.org/10.1186/1752-1947-8-149
[57] Phlegmasia Cerulea Dolens, a Deadly Complication of Deep Vein Thrombosis: Case Report and Review of Literature. — https://doi.org/10.7759/cureus.19927
[64] Successful Intravascular Ultrasound-Guided Thrombus Removal and Angioplasty for Phlegmasia Cerulea Dolens in a Young Male With a History of Multiple Lower Extremity Deep Vein Thrombosis. — https://doi.org/10.7759/cureus.39739
[65] Right Lower Extremity Phlegmasia Cerulea Dolens Due to Iliotibial Vein Thrombosis With Compartment Syndrome and Circulatory Shock: Case Report and Review. — https://doi.org/10.7759/cureus.32364
[66] Fulminant phlegmasia cerulea dolens with concurrent cholangiocarcinoma and a lupus anticoagulant: a case report and review of the literature. — https://doi.org/10.1097/mbc.0000000000000057
[71] A Case of Phlegmasia Cerulea Dolens in a Patient With COVID-19, Effectively Ttreated With Fasciotomy and Mechanical Thrombectomy. — https://doi.org/10.1016/j.avsg.2021.07.034
[73] Unraveling the risk factors, prognostic predictors, and evolving therapeutic approaches for phlegmasia cerulea dolens over 30 years. — https://doi.org/10.1080/07853890.2025.2577880
[76] Endovascular treatment of phlegmasia cerulea dolens with impending venous gangrene: manual aspiration thrombectomy as the first-line thrombus removal method. — https://doi.org/10.1007/s00270-010-0042-5
[77] Hypercoagulability Due to COVID-19 Leading to Impending Phlegmasia Cerulea Dolens and Sub-Massive Bilateral Pulmonary Embolism. — https://doi.org/10.7759/cureus.17351
[79] Single-Stage Endovascular Thrombectomy and Stenting as the First-Line Strategy in the Treatment of Phlegmasia Cerulea Dolens Caused by Iliac Vein Lesions. — https://doi.org/10.1016/j.avsg.2023.01.003
[80] Venous thromboembolism secondary to uterine fibroids: a case of phlegmasia cerulea dolens and review of the literature. — https://doi.org/10.1016/j.avsg.2014.09.021
[84] Multimodal approach of venous recanalization in patients with a critical limb ischemia due to phlegmasia cerulea dolens: A case series of 17 patients in a single center. — https://doi.org/10.1177/0268355520935744
[85] Transjugular ultrasound-assisted catheter direct fibrinolysis (EKOS) for relapsed IVC filter thrombosis and phlegmasia cerulea dolens. — https://doi.org/10.1016/j.radcr.2024.09.058
[87] Endovascular treatment of traumatic iliac venous injury combined with phlegmasia cerulea dolens in Korea: a case report. — https://doi.org/10.20408/jti.2022.0039
[99] Half-Dose Anticoagulation for Venous Thromboembolism and Phlegmasia Cerulea Dolens in a Patient With Recurrent Subdural Hematoma. — https://doi.org/10.7759/cureus.18048
[101] Upper limb phlegmasia cerulea dolens treated with single-session suction thrombectomy: a case report. — https://doi.org/10.1093/jscr/rjaa364
[103] Acetabular and pelvic fracture repair complicated by phlegmasia cerulea dolens: A report of limb salvage with open thrombectomy and modified Palma procedure. — https://doi.org/10.1016/j.jvscit.2024.101544
[106] Successful treatment of phlegmasia cerulea dolens with combination surgical and catheter-assisted thrombectomy. — https://doi.org/10.2310/6670.2008.00057
[109] Mechanical Thrombectomy for Iliofemoral Deep Venous Thrombosis Complicated by Phlegmasia Cerulea Dolens in a Pregnant Patient With May-Thurner Syndrome: A Case Report. — https://doi.org/10.7759/cureus.86570
[110] Upper Limb Phlegmasia Cerulea Dolens Secondary to Heparin-induced Thrombocytopenia Leading to Gangrene. — https://doi.org/10.7759/cureus.2853
[117] Rare Case of Unilateral Phlegmasia Cerulea Dolens With Bilateral Deep Vein Thrombosis at a Community Military Hospital Emergency Department. — https://doi.org/10.7205/milmed-d-16-00346
[125] Mechanical thrombectomy of COVID-19 DVT with congenital heart disease leading to phlegmasia cerulea dolens: a case report. — https://doi.org/10.1186/s12872-021-02403-w
[134] Severe Acute Respiratory Syndrome Coronavirus 2 Infection and Thrombosis: Phlegmasia Cerulea Dolens Presenting with Venous Gangrene in a Child. — https://doi.org/10.1016/j.jpeds.2020.07.032
[143] A 61-Year-Old Man with SARS-CoV-2 Infection and Venous Thrombosis Presenting with Painful Swelling and Gangrene of the Lower Limb Consistent with Phlegmasia Cerulea Dolens. — https://doi.org/10.12659/ajcr.928342
[144] Effectiveness and safety of catheter-directed thrombolysis in conjunction with percutaneous mechanical thrombectomy for acute iliofemoral deep vein thrombosis: A meta-analysis. — https://doi.org/10.1016/j.jvsv.2023.01.010
[147] Lower extremity compartment syndrome in the setting of iliofemoral deep vein thrombosis, phlegmasia cerulea dolens and factor VII deficiency. — https://doi.org/10.1136/bcr-2016-215078
[149] Iliac Vein Stenting and Thrombectomy Result in Limb Salvage in Phlegmasia Caerulea Dolens as a Result of Heavy Fibroid Burden. — https://doi.org/10.1177/00031348241248692
