MASSIVE venous thrombosis is a dramatic event of surgical practice with vivid manifestations of excruciating pain, extensive fluid loss into the affected extremity, and eventual gangrene. Because of this and the relatively poor results of all treatments, phlegmasia cerulea dolens has occasioned frequent reports in the surgical literature (Table 1). The many reports list numerous methods attempting to reduce the complications of this condition. The many forms of therapy are testimony to the fact that no single treatment is satisfactory. Enthusiasm for each mode of care waxes and wanes.
Until three decades ago, treatment of phlegmasia cerulea dolens consisted mainly of limb elevation and heparin administration. Sympathetic blockade advocated by Leriche and Kunlin in 1934 and later recommended by DeBakey represented an attempt to halt associated venous and arterial spasm.1 This adjuvant therapy effected some improvement in the morbidity and mortality figures. Boyd and Clarke showed that sympathectomy reduced