Gangrene of Lower Extremity Secondary to Extensive Venous Occlusion

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Abstract
Gangrene of the lower extremity caused by extensive venous occlusion is an uncommon entity. A study has been made of 11 such cases encountered at the Mayo Clinic during the 31-year period ending in 1959. Only one of the patients was alive at the time of the study. Neoplastic disease was the most frequently observed underlying process in this series. Despite extensive venous occlusion, with involvement of the inferior vena cava in 5 cases, the renal vein was involved in only one. Peripheral circulatory failure with shock occurred in 3 patients and was a grave prognostic sign. The commonest cause of death was pulmonary embolism. Complete obstruction to the venous return is probably the basic etiologic factor, but further study of the extremely small arteries and arterioles is necessary before the cause of this type of gangrene can be known with certainty. The management of phlegmasia cerulea dolens and complicating peripheral circulatory failure is not satisfactory. Shock should be treated by the early use of blood.

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