Phlegmasia

Phlegmasia, Phlegmasia Alba Dolens, Milk Leg Syndrome, Phlegmasia Cerulea Dolens, Copper Leg Syndrome, Venous Gangrene

Phlegmasia (milk leg)
1. Venous outflow obstruction
  1. Typically left sided due to left common iliac vein course beneath the left common iliac artery
2. Progression along a spectrum
  1. Phlegmasia Alba Dolens
  2. Phlegmasia Cerulea Dolens
  3. Venous Gangrene
Phlegmasia Alba Dolens (Milk Leg Syndrome)
1. Pale white, painful, severely edematous extremity (milk leg)
2. Proximal deep vein obstruction with patent collateral veins
Phlegmasia Cerulea Dolens (Copper Leg Syndrome)
1. Cyanotic or blue, severely edematous extremity (copper leg) with obstructed collateral veins
2. Pain out of proportion to appearance
3. Like Alba Dolens, Cerulea Dolens is associated with proximal deep vein obstruction
  1. However, collateral or superficial veins are also obstructed leading to greater venous obstruction and Cyanosis
Venous Gangrene
1. Thrombosis extends into the capillaries
2. Associated with Septic Shock and need for Limb Amputation
May-Thurner Syndrome
1. Left common iliac vein compressed by right femoral artery and spurring from Vertebrae
2. Presents with unilateral left Leg Edema and venous Hypertension

Ilio-femoral Deep Vein Thrombosis
1. Malignancy
2. Hypercoagulable State
3. Trauma
Anatomic Compression
1. May-Thurner Syndrome (typically left-sided)
2. Pregnancy

Vascular surgery Consultation in all cases
Phlegmasia Alba Dolens
1. Medical management in most cases (if DVT)
Phlegmasia Cerulea Dolens
1. Emergent surgical thrombectomy or
2. Emergent directed Thrombolytics

Untreated Phlegmasia (esp. cerulea) is associated with very high mortality (20 to 50%)