VENOUS GANGRENE OF THE EXTREMITIES

Objective: To review the rare clinical condition of venous gangrene of the extremities, particularly in association with malignant disease; to develop a treatment scheme for this difficult condition. Data Sourc es: Surgical articles on phlegmasia cerulea dolens, venous gangrene an d other forms of noninfectious, nonarterial gangrene of the extremitie s from 1937 to the present were identified from published indexes and computer databases; experience with four additional cases treated by t he authors is incorporated. Study Selection: Studies selected for deta iled review include those involved directly with venous gangrene and i ts investigation and treatment, and those relating to investigation of clinically similar conditions. Data Extraction: Because of the rarity of venous gangrene, much of the available literature is descriptive, involves small numbers of cases and describes only limited experience with investigation and treatment; data extraction was done by a single reviewer. Data Synthesis: Because of advances in diagnostic technolog y and thrombosis research, the assessment of suspected venous gangrene has changed significantly in recent years. Despite these advances, th e prognosis for patients with this condition continues to be poor. The possible confounding roles of paradoxical reactions to anticoagulants and of primary hypercoagulable states are considered. Conclusions: Ob jective demonstration of extensive thrombosis of the large veins of th e involved extremity remains central to the diagnosis. The presence an d stage of any associated malignant lesion must be rapidly determined to allow planning for further treatment. Because conventional anticoag ulation frequently fails, it may be necessary to consider less well-es tablished modes of therapy.