Phlegmasia cerulea dolens (PCD) can be a threat to both life and limb and therefore must receive prompt treatment. In most clinical settings,
anticoagulant therapy is standard treatment for PCD. Iliofemoral
thrombectomy has been recommended as surgical treatment of massive
thrombosis where venous
gangrene may occur. In the severely traumatized patient, however, massive venous occlusion presents difficulties in management in a complex clinical setting. We have described a 52-year-old white man who had a posterior
fracture dislocation of the right hip, with a pulseless, cyanotic, swollen right leg. A Greenfield filter was placed via the internal jugular vein approach, followed by leg and thigh
fasciotomy and iliofemoral
thrombectomy. Femoral arteriotomy revealed good inflow, and arterial
thrombectomy yielded very little
thrombus. He subsequently required an above-knee
amputation for venous
gangrene. In cases of PCD, iliofemoral
thrombectomy should be considered early when the threat of venous
gangrene exists. We propose internal jugular vein placement of a Greenfield filter before venous
thrombectomy. The Greenfield filter has proven to be a safe and effective prophylaxis for
thromboembolism should a clot migrate or detach during
thrombectomy. Additionally, placement of the filter in the early post-traumatic period would safeguard against pulmonary emboli during a period in which anti-
coagulant therapy would be contraindicated.