Measurement of intramuscular pressure in the management of massive venous occlusion.

While controversy continues over the exact pathophysiology of and optimal therapy for phlegmasia cerulea dolens, increasing evidence favors the role of elevated interstitial pressure in the generation of extremity ischemia. We report the use of intramuscular pressure measurements in the assessment of a patient suffering massive venous occlusion of one leg. Significant elevations in pressure were found in association with symptomatic ischemia. Successful thrombectomy restored blood flow, relieved symptoms, and produced an immediate decrease in intramuscular pressure. In this disorder, measurement of compartment pressures can be useful in assessing the severity of venous insufficiency and in monitoring the response to therapy.