View source for Venous gangrene

==Background==
*Massive iliofemoral or IVC occlusion with patent arteries
*Extensive vascular congestion and venous ischemia
*Involves superficial collateral veins
*40-60% of phlegmasia cerulea dolens with capillary involvement progress to venous gangrene

===Risk Factors===
*Age 50-60s
*Malignancy (over half)
*Thrombophlebitis migrans
*Acquired [[hemolytic anemia]] due to cold-antibodies
*Typical risk factors for [[DVT]] (pregnancy, surgery, trauma, hypercoagulable syndrome)
*Idiopathic

==Clinical Features==
*Limb pain
*Severe edema
*Cyanosis
*Blistering and extravasation
*Purplish black well-circumscribed areas
*Superficial gangrene and necrosis
*Arterial patency
*Not reversible (vs. [[phlegmasia cerulea dolens]] and [[phlegmasia alba dolens]] are)
*Fluid sequestration and circulatory [[shock]]

==Differential Diagnosis==
{{Venous thromboembolism types}}

===Others===
*[[Cellulitis]]
*[[Lymphedema]]
*Venous valvular insufficiency
*[[Superficial thrombophlebitis]]
*[[Arterial embolism]]
*[[Diabetic ulcer]]
*Wet/gas [[gangrene]]

==Evaluation==
*Clinical diagnosis
*[[Ultrasound: DVT|Duplex US]]
*Contrast venography
*MRV

==Management==
*Interventional radiology consult for emergent catheter-directed thrombolysis
*Vascular surgery consult for thrombectomy
*Steep limb elevation
*Fluid resuscitation ([[PRBC]])
*[[Heparin]]: 80-100U/kg followed by infusion of 15-18U/kg/hr
*Thrombolytic: [[Alteplase]] (1mg/min to total of 50mg) distal to thrombus

==Disposition==
*Admit

==See Also==
*[[Venous thromboembolism]]

==External Links==

==References==
<references/>

[[Category:Cardiology]]
[[Category:Orthopedics]]
[[Category:Vascular]]