Hartung Olivier, Barthelemy Pierre, Arnoux Dominique, Boufi Mourad, Alimi Yves S
Service de Chirurgie Vasculaire, Centre Hospitalier Universitaire Nord, Marseille, France.
J Vasc Surg. 2009 Aug;50(2):355-9. doi: 10.1016/j.jvs.2009.01.034.
Ilio-caval stenting now represents the first line treatment for disabling obstructive ilio-caval lesions. Most patients are young women of child-bearing age. We herein report our experience of pregnancy in women who have a history of ilio-caval stenting.
From November 1995 to April 2008, 119 patients had ilio-caval stenting for obstructive venous disease in our department. Of these, 62 women were able to become pregnant. When pregnancy occurred, they received preventive treatment with low molecular weight heparin (LMWH) from the 3rd month of pregnancy to 1 month after delivery and had to wear elastic stockings. Patients also had to sleep on their right side if possible. They were followed during the pregnancy by duplex scanning at 3, 6, and 8 months, and then 1 month after delivery.
Eight pregnancies occurred in 6 patients (mean age 26.5 years) who had a patent self-expanding stent (1 patient had 3 pregnancies). They had stenting for May-Thurner disease in 3 patients, for post-deep venous thrombosis (DVT) left common iliac vein occlusion in 1 patient, and during venous thrombectomy in 2 patients. All stents were self-expanding metallic stents located on the left common iliac vein. One patient had unrelated spontaneous abortion after 2 months of pregnancy. No DVT or symptomatic pulmonary embolism occurred during pregnancy, delivery, or during the postpartum period. Four patients needed cesarean delivery and none had hemorrhagic complications. None of the patients had adverse effects from the treatment. Duplex scan showed compression of the stent(s) at 8 months in 4 patients with inflow obstruction in 3 patients. Postpartum duplex-scan showed no remaining stenosis in all patients. No stents had structural damage.
Ilio-caval stent compression can occur during pregnancy but does not lead to structural damage to the self-expanding stents. Despite this, no cases of DVT occurred with preventive LMWH treatment.
髂股静脉支架置入术目前是治疗致残性髂股静脉阻塞性病变的一线治疗方法。大多数患者为育龄期年轻女性。我们在此报告有髂股静脉支架置入术病史的女性怀孕的经验。
1995年11月至2008年4月，我科有119例患者因阻塞性静脉疾病接受了髂股静脉支架置入术。其中，62名女性能够怀孕。怀孕后，她们从妊娠第3个月至产后1个月接受低分子肝素（LMWH）预防性治疗，并必须穿着弹力袜。患者还必须尽可能右侧卧位睡眠。在妊娠期间，于妊娠3、6和8个月以及产后1个月进行双功超声扫描随访。
6例患者（平均年龄26.5岁）发生了8次妊娠，这些患者的自膨式支架通畅（1例患者有3次妊娠）。3例患者因May-Thurner病行支架置入术，1例患者因深静脉血栓形成（DVT）后左髂总静脉闭塞行支架置入术，2例患者在静脉血栓切除术期间行支架置入术。所有支架均为位于左髂总静脉的自膨式金属支架。1例患者在妊娠2个月后发生无关的自然流产。妊娠、分娩或产后期间均未发生DVT或有症状的肺栓塞。4例患者需要剖宫产，无一例发生出血并发症。所有患者均未出现治疗的不良反应。双功超声扫描显示，4例患者在8个月时支架受压，3例患者有流入道梗阻。产后双功超声扫描显示所有患者均无残余狭窄。没有支架发生结构损坏。
妊娠期间可发生髂股静脉支架受压，但不会导致自膨式支架结构损坏。尽管如此，预防性LMWH治疗未发生DVT病例。
