Dua Anahita, Rothenberg Kara A, Rao Christina, Desai Sapan S
Division of Vascular Surgery, Department of Surgery, Stanford Hospital and Clinics, Palo Alto, CA.
Division of Vascular Surgery, Department of Surgery, Stanford Hospital and Clinics, Palo Alto, CA; Department of Surgery, University of California San Francisco - East Bay, Oakland, CA.
Ann Vasc Surg. 2019 Aug;59:313.e1-313.e3. doi: 10.1016/j.avsg.2019.01.018. Epub 2019 Apr 19.
Pregnancy is a hypercoagulable state associated with a fivefold increase in the risk of venous thromboembolism. Thrombolysis is the preferred level of care for patients with acute iliofemoral deep vein thrombosis (DVT); however, most studies exclude pregnant patients, highlighting the lack of data regarding the efficacy and safety of thrombolytic therapy for mother and fetus.
We describe the successful use of thrombolytic therapy in conjunction with ultrasound to remove a large ileofemoral DVT in a first-trimester patient with phlegmasia cerulea dolens. The procedure was performed safely for both mother and fetus.
No radiation or contrast dye was used, and intravascular ultrasound confirmed patency of the entirety of the venous system. She delivered a healthy term baby after the procedure and had no further sequalae.
Thrombolysis with intravascular ultrasound may be considered in first-trimester pregnant patients with threatened limb due to DVT.
