Endovascular treatment of iliofemoral deep vein thrombosis in pregnancy using US-guided percutaneous aspiration thrombectomy

Abstract

P regnancy is a risk factor for venous thromboembolism (VTE) and the risk is highest in the postpartum period (1, 2). Anticoagulants are very effective in the prevention of pulmonary embolism (PE) and recurrent thrombosis, but the treatment of deep vein thrombosis (DVT) remains a challenge, because lysis of the thrombus formed in the deep veins is slow and frequently inadequate as a therapy (3, 4). Complete or significant lysis occurs only in 4% of patients treated with heparin alone (3). Persistence of thrombus within deep veins leads to venous hypertension, which is ultimately the cause of post-thrombotic syndrome (PTS) and late disability in 20% to 50% of patients. PTS is a conglomerate of lifestyle-limiting symptoms that commonly includes chronic leg pain and swelling, heaviness, and/or fatigue, venous claudication, stasis dermatitis, and in advanced cases skin ulcerations due to valvular incompetence accompanied by persistent venous outflow obstruction (4-8). Pregnant women are generally younger than other women in the general population, and they likely suffer a more severe form of PTS for a much longer time.Anticoagulants have been the standard therapy of DVT in pregnant women because of concerns related to administering contrast agent, exposing the fetus to radiation during interventional radiologic procedures, and bleeding complication associated with thrombolysis (9). Nonetheless, there are a few publications describing thrombolytic therapy of DVT with good success during pregnancy and peri-or postpartum period (10-13). In a previous study (14), a pregnant woman with DVT was treated using percutaneous mechanical thrombectomy under venographic guidance with contrast agent. Percutaneous aspiration thrombectomy (PAT) with or without fluoroscopy guidance in preg- 71From the Department of Radiology (M.G. 

Vascular Manifestations of Behçet’s Disease

“…DVT also can be ameliorated using thromboaspiration as an adjunct to conventional low-molecular-weight heparin treatment which is usually advised for a duration of 6 months. It has been reported that endovascular treatment with US-guided percutaneous aspiration thrombectomy can be considered as a safe and effective way to remove thrombus from the deep veins in pregnant women with acute and subacute iliofemoral deep vein thrombosis [22]. The effectiveness of this method is also corroborated in studies reporting about endovascular treatment of postpartum deep vein thrombosis [23,24].…”

A unique case of hypoplastic inferior vena cava leading to bilateral iliofemoral venous outflow obstruction and review of literature

“…Although not exclusively for patients with hypoplastic IVC, recent studies have demonstrated that early endovascular thrombectomy of lower extremity DVTs could decrease the risk of PTS and post-DVT sequela. 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 The Table 1 summarizes contemporary studies reporting on the outcomes of thrombolysis-free suction or aspiration endovascular thrombectomy for with acute and subacute lower extremity. No clinical trials including patients with IVC hypoplasia or atresia and contemporary iliofemoral DVTs were identified with head-to-head comparisons among the several treatment approaches (ie, anticoagulation vs thrombolysis vs revascularization techniques).…”

Safety and Efficacy of Endovascular Treatment on Pregnancy-Related Iliofemoral Deep Vein Thrombosis

“…12,23,38,39 Ultrasound guidance is a better approach to this concern. 40 Appropriate radiation protection precautions should be considered in regulating fetal exposure under the maximal accepted limit for major organ malformation. 41 We also noted a successful delivery after minimized radiation in pregnant patients in all three trimesters at different case series.…”