Phlegmasia cerulea dolens as an initial manifestation of a fistula between a ruptured iliac artery aneurysm and the iliac vein

Abstract Phlegmasia cerulea dolens (PCD) is caused by obstruction of limb venous return that may result in venous gangrene and limb loss. We present a case of a fistula between a ruptured right common iliac artery aneurysm and the left common iliac vein (ilioiliac arteriovenous fistula [AVF]), which initially manifested as left PCD and acute renal failure. Resection of the aneurysm and repair of the AVF immediately improved the PCD and acute renal failure. We should be aware that an iliac AVF might present as PCD and should keep this in mind.