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妊娠期静脉血栓栓塞症管理。

Venous Thromboembolism Management in Pregnant Patients.

机构信息

Division of Vascular and Interventional Radiology, Department of Diagnostic, Molecular & Interventional Radiology, Mount Sinai Health System, New York, NY.

Division of Vascular and Interventional Radiology, Department of Diagnostic, Molecular & Interventional Radiology, Mount Sinai Health System, New York, NY.

出版信息

Tech Vasc Interv Radiol. 2023 Jun;26(2):100901. doi: 10.1016/j.tvir.2023.100901. Epub 2023 Aug 5.

Abstract

Pulmonary embolism (PE) in pregnancy accounts for 10% of maternal deaths in the United States. As maternal morbidity and mortality continue to increase, it is imperative for all specialties interfacing with pregnant patients to understand the current research and guidelines surrounding risk stratification, diagnosis, and treatments of PE in pregnancy. Given the complexity of high-risk pregnancy-associated PE (PA-PE), that is, which is associated with hemodynamic instability or collapse, and the rising popularity of new technologies to treat high-risk PA-PE in the nonpregnant population, this review aims to emphasize the differences in diagnosis, risk stratification, and management of the pregnant and nonpregnant PE patients. Furthermore, this review will cover treatment paradigms that include anticoagulation versus advanced therapies such as systemic thrombolysis, surgical embolectomy, extracorporeal membrane oxygenation, and inferior vena cava disruption as well as the more novel therapies which fall under the umbrella term of catheter-based treatments. Finally, this review will include a case-based review of 2 patients with PA-PE requiring catheter-based therapies and their ultimate clinical outcomes.

摘要

妊娠合并肺栓塞(PE)在美国占孕产妇死亡的 10%。随着孕产妇发病率和死亡率的不断上升,所有与孕妇有交集的专业都必须了解目前关于妊娠合并 PE 的风险分层、诊断和治疗的研究和指南。鉴于与血流动力学不稳定或崩溃相关的高危妊娠相关肺栓塞(PA-PE)的复杂性,以及在非孕妇人群中用新技术治疗高危 PA-PE 的日益普及,本综述旨在强调妊娠和非妊娠 PE 患者在诊断、风险分层和管理方面的差异。此外,本综述将涵盖治疗模式,包括抗凝与全身溶栓、手术取栓、体外膜氧合和下腔静脉阻断等先进治疗方法,以及属于导管治疗范畴的更新型治疗方法。最后,本综述将包括 2 例需要导管治疗的 PA-PE 患者的病例回顾及其最终临床结局。

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