Gangrene of lower extremity secondary to extensive venous occlusion.

G ANGRENE of an extremity caused by venous occlusion without associated arterial occlusion is uncommon. Haimovicil noted that Fabricus Hildanus, in 1593, apparently recognized the possibility of gangrene of venous origin; it was not until 1859, however, that Heuter2 reported a case, giving an excellent account of the clinical and pathologic criteria of this type of gangrene. Gregoire,3 in 1938, coined the term "phlegmasia cerulea dolens" to denote extensive venous occlusion that is characterized by cyanosis, ischemia, woody edema, violaceous discoloration, ecehymosis, and transient loss or reduction of arterial pulsations. Like Tremolieres and Wran,4 who described this condition in 1929, Gregoire attributed the ischemia to secondary arteriospasm. Buerger,5 in a book published in 1924, mentioned only that complete obstruction of the chief veins of a part without occlusion of the arteries, may also lead to gangrene, although this is of rare occurrence. It was not until 1938 that Tilley6 made the first report of this condition in the American literature; in the same year, Pringle7 documented the first two cases in the English literature. In Tilley 's three cases, clinical data are lacking, but careful dissection of the amputated limbs revealed "obstruction of all the veins; the arteries were grossly normal and no obstruction could be demonstrated." Ten years later, Haimovici and Suffness8 reported a fourth case in the American literature and again brought the clinicopathologic characteristics to the attention of physicians in the United States. Although sporadic reports of phlegmasia cerulea dolens have ap-