Acetabular and pelvic fracture repair complicated by phlegmasia cerulea dolens: A report of limb salvage with open thrombectomy and modified Palma procedure

A 57-year-old male presented after a fall, which resulted in acetabular and pelvic fractures. He underwent fracture fixation, which was complicated by iliac vein occlusion, leading to phlegmasia cerulea dolens. He underwent lower extremity surgical venous thrombectomy, contralateral iliac vein stent placement, and modified Palma procedure with an ePTFE venous cross-over bypass and arteriovenous fistula creation. His post-operative course was unremarkable and he regained full function of the extremity without significant stasis complications. The bypass and stent remain patent three years post-operatively. Although iliac vein injury during acetabular fracture repair is rare, prompt recognition and intervention prevents limb loss.