Pharmacomechanical Catheter-Directed Thrombolysis for Pregnancy-Related Iliofemoral Deep Vein Thrombosis

Bloom, Allan I.; Farkas, A.; Kalish, Yossi; Elchalal, Uriel; Spectre, Galia

doi:10.1016/j.jvir.2015.03.001

Cited by 33 publications

(54 citation statements)

References 15 publications

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“…Radiation induces cell death likely inhibiting the implantation of an embryo, resulting in miscarriage. 8 Animal studies show doses as small as 10 to 20 rad can be lethal for a 3- to 4-week gestation. 9 Interestingly, however, malformation rates of surviving embryos during this preorganogenesis stage are similar to nonradiated controls, thus confirming the “all-or-none” phenomenon seen in animal models.…”

Section: Discussionmentioning

confidence: 99%

“…It is reported that the fetal radiation dose resulting from pharmacomechanical catheter-directed thrombolysis in the first trimester can be as high as 25 rad, which is associated with a childhood risk of 1.3 to 2%. 8 Malformations such as microcephaly, microphthalmia, growth restriction, and cataracts may occur between 3 and 8 weeks of gestation. 6 Development of the fetal central nervous system occurs between gestational weeks 8 and 25; therefore, cognitive and/or behavioral deficits may occur if in utero exposure exceeds radiation doses of 35 to 50 rad during this period.…”

Section: Discussionmentioning

confidence: 99%

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Phlegmasia Cerulea Dolens and May–Thurner Syndrome in the first trimester of Pregnancy

Ladha

Fareeduddin

2015

AJP Rep

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Background Venous thromboembolism in pregnancy remains one of the leading causes of morbidity and mortality. Case A young, gravid patient presented with a cyanotic, edematous left lower extremity with no distal pulses palpable. She was emergently taken to the operating room and was found to have extensive iliofemoral thrombosis requiring femoral angioplasty and embolectomy with 43.7-rad intraoperative radiation exposure. Phlegmasia cerulea dolens and May–Thurner syndrome were diagnosed. Conclusion Timely diagnosis and prompt surgical management are necessary due to the limb-threatening nature of this condition. Despite maternal radiation exposure, the nature and extent of fetal effects depends upon radiation dose and gestational age.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Phlegmasia Cerulea Dolens and May–Thurner Syndrome in the first trimester of Pregnancy

Ladha

Fareeduddin

2015

AJP Rep

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“…Computed tomography angiography, magnetic resonance angiography, computed tomography venography, magnetic resonance venography as noninvasive examination is helpful for the diagnosis of iliac vein stenosis or occlusion, and it can identity the compression from the right iliac artery 14 , but it is more expensive, cannot be widely used. In addition, we also found that the left iliac vein was compressed by the right iliac artery 15 , resulting in collapse and adhesion in the earlier traditional surgical treatment.…”

Section: Discussionmentioning

confidence: 68%

Mid-and long-term efficacy of endovascular-based procedures for Cockett syndrome

Liu

Zhou

2018

Sci Rep

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To investigate the mid- and long-term results of endovascular-based procedures for Cockett syndrome. The clinical data of 412 patients with Cockett syndrome treated between January 2003 and September 2017 were retrospectively analyzed. In these patients, 231 cases were acute left iliac femoral vein thrombosis (group A), and 181 cases were chronic venous insufficiency (group B), and different endovascular procedures and/or hybrid procedures were performed. In group A, the technique success rate was 100% (231/231); the left iliac vein in 5 patients showed no stenosis or occlusion, and the incidence of pathological changes in the left iliac vein was 97.8% (226/231); a total of 182 stents were implanted. In group B, the technique success rate was 99.4% (180/181); the average pressure difference between the proximal and distal portion of the pathological left iliac veins decreased from preoperative (18 ± 4.45) cmH2O to postoperative (4 ± 3.02) cmH2O (P < 0.01); 89 patients, complicated with valvular incompetence in the left superficial femoral vein, underwent a second-stage femoral valve repair. Follow-up ranged from 3 months to 8 years, with an average of 35.6 months, and intrastent thrombosis occurred in 15 cases of group A and in 2 cases of group B. Endovascular-based procedures offer favorable mid- and long-term results in treatment of Cockett syndrome, which in combination with Fogarty catheter thrombectomy or catheter-directed thrombolysis is a beneficial complementary treatment for patients with acute iliac femoral vein thrombosis.

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“…The fetal radiation dose resulting from catheter-directed thrombolysis in the first trimester can be calculated in the range of 175-245 mGy, which is associated with a childhood cancer risk of 1.3%-2%. This value is 6 to 10 times higher than the risk associated with environmental/background radiation exposure (18).…”

Section: Discussionmentioning

confidence: 77%

“…Because of the potential risks of the fetal radiation exposure another case report described elective termination of pregnancies following CDT in the first trimester (18). This approach was however not acceptable for our patient.…”

Section: Discussionmentioning

confidence: 88%

Radiation- and contrast medium-free catheter-directed thrombolysis for early pregnancy-related massive iliocaval deep venous thrombosis

Huegel

Surbek

Mosimann

et al. 2019

Journal of Vascular Surgery: Venous and Lymphatic Disorders

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Catheter-directed thrombolysis for iliofemoral deep venous thrombosis (DVT) aims to reduce acute leg symptoms and to prevent the post-thrombotic syndrome. There are no data from controlled trials in pregnant patients. Reports of thrombolysis for treatment of DVT during pregnancy are scarce. Pregnancy is considered a relative contraindication to thrombolytic therapy because of the risk of bleeding and concerns about the effects of radiation exposure on the fetus. We report on a catheter-directed thrombolysis procedure without radiation and contrast medium exposure in a first-trimester pregnant patient with massive iliofemoral DVT and free-floating thrombus extending to the suprarenal inferior vena cava.

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Pharmacomechanical Catheter-Directed Thrombolysis for Pregnancy-Related Iliofemoral Deep Vein Thrombosis

Cited by 33 publications

References 15 publications

Phlegmasia Cerulea Dolens and May–Thurner Syndrome in the first trimester of Pregnancy

Phlegmasia Cerulea Dolens and May–Thurner Syndrome in the first trimester of Pregnancy

Mid-and long-term efficacy of endovascular-based procedures for Cockett syndrome

Radiation- and contrast medium-free catheter-directed thrombolysis for early pregnancy-related massive iliocaval deep venous thrombosis

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