Aburahma A F, Mullins D A
Vascular Laboratory and the Department of Surgery, Robert C. Byrd Health Sciences Center, West Virginia University, Charleston, USA.
J Vasc Surg. 2001 Feb;33(2):375-8. doi: 10.1067/mva.2001.111488.
The choice of therapy for deep vein thrombosis (DVT) of the lower extremity during pregnancy has been widely debated. Warfarin passes through the placenta to the fetus and may cause fetal complications and/or death. Heparin, in contrast, does not cross the placenta, but its long-term use may be impractical and may increase the risk of bleeding, osteoporosis, and neurologic complications. The use of inferior vena cava filters in pregnancy has only been described as case reports in the English medical literature; therefore, this study reviews our experience on this subject.
We analyzed 18 pregnant patients who had Greenfield filters (GFs) inserted for DVT of the lower extremity, pulmonary embolism (PE), or both. The DVT diagnosis was made by means of duplex imaging. Conventional full-dose intravenous heparin was initiated until the filter was inserted, followed by subcutaneous heparin until labor, and continued for 6 weeks postpartum in 13 patients who were breast-feeding. Warfarin was given postpartum in the other five patients.
The mean age of the patients was 25 years. The indications for GF insertion included 3 patients who had a PE while on anticoagulation, 2 patients with significant bleeding caused by anticoagulation, 4 patients with free-floating iliofemoral DVT, 2 patients with heparin-induced thrombocytopenia, and 7 patients with iliofemoropopliteal DVT occurring 1 to 3 weeks before labor, for prophylactic reasons. Fourteen of 18 cases were diagnosed in the third trimester of the patient's pregnancy. Filters were inserted via the right internal jugular vein by means of a cut-down technique in the first four patients (stainless steel filters) and percutaneously in 14 patients. The mean fluoroscopy time during filter insertion was less than 2 minutes. There was no fetal or maternal morbidity or mortality. During long-term follow-up (mean, 78 months), no PE or filter-related complications were encountered.
GF insertion in pregnant patients with DVT of the lower extremity is safe and effective. Its prophylactic use in pregnant patients who have extensive iliofemoral DVT right before labor may be justified.
孕期下肢深静脉血栓形成（DVT）的治疗选择一直存在广泛争议。华法林可通过胎盘进入胎儿体内，可能导致胎儿并发症和/或死亡。相比之下，肝素不会穿过胎盘，但其长期使用可能不切实际，且可能增加出血、骨质疏松和神经并发症的风险。孕期使用下腔静脉滤器在英文医学文献中仅有病例报告；因此，本研究回顾了我们在该主题上的经验。
我们分析了18例因下肢DVT、肺栓塞（PE）或两者而植入格林菲尔德滤器（GF）的孕妇。DVT诊断通过双功成像进行。在植入滤器前开始常规全剂量静脉注射肝素，随后皮下注射肝素直至分娩，13例母乳喂养的患者产后继续使用6周。另外5例患者产后给予华法林。
患者的平均年龄为25岁。植入GF的指征包括3例在抗凝治疗期间发生PE的患者、2例因抗凝导致严重出血的患者、4例游离性髂股DVT患者、2例肝素诱导的血小板减少症患者以及7例因预防性原因在分娩前1至3周发生髂股腘静脉DVT的患者。18例病例中有14例在患者妊娠晚期被诊断。前4例患者（不锈钢滤器）通过切开技术经右颈内静脉植入滤器，14例患者经皮植入。滤器植入期间的平均透视时间少于2分钟。未发生胎儿或母体发病或死亡。在长期随访（平均78个月）期间，未遇到PE或与滤器相关的并发症。
孕期下肢DVT患者植入GF是安全有效的。在临产前患有广泛髂股DVT的孕妇中预防性使用GF可能是合理的。
