Serrano Reyes Jose Carlos, Pinilla Rolando, Chanis Gilberto, Jaen Rolando, Valdes Jose
General Medicine, Paitilla Hospital, University of Panama, Panama, PAN.
Critical Obstetrics, Gynecology and Obstetrics, Paitilla Hospital, University of Panama, Panama, PAN.
Cureus. 2025 Jun 22;17(6):e86570. doi: 10.7759/cureus.86570. eCollection 2025 Jun.
This case report describes a 35-year-old, G1P0 patient at 24 weeks and three days of gestation with no significant medical history, who presented with edema and discoloration of the left lower extremity, accompanied by left inguinal pain. These symptoms followed three days of low back pain radiating to the same region. On physical examination, findings were suggestive of deep venous thrombosis (DVT). Point-of-care ultrasound and venous Doppler confirmed thrombosis extending from the left proximal femoral vein to the left external iliac vein. To further assess the thrombus burden and anatomical extent, a computed tomography (CT) venography was performed following informed consent. CT venography demonstrated a thrombus extending from the left external iliac vein through the left common iliac vein to its junction with the inferior vena cava (IVC). The left common iliac vein was notably compressed by the overlying right common iliac artery, causing retrograde venous congestion and supporting the diagnosis of iliofemoral DVT secondary to May-Thurner syndrome. After thorough multidisciplinary discussion and risk-benefit evaluation, and with the patient's informed consent, an interventional approach was undertaken. Initial management included anticoagulation with enoxaparin, partial mechanical thrombectomy, and placement of an IVC filter. On the second day post-procedure, the patient developed acute worsening of edema, progressive skin discoloration, decreased temperature of the affected limb, and diminished palpable pulses, raising concern for arterial compromise consistent with phlegmasia cerulea dolens. In response, an extensive mechanical thrombectomy was promptly performed, resulting in improved distal venous outflow and clinical stabilization. This case demonstrates that, in selected pregnant patients with extensive or complicated iliofemoral DVT, mechanical thrombectomy within a multidisciplinary care framework can be a safe and effective therapeutic option to achieve rapid symptom relief and potentially reduce short- and long-term complications.
本病例报告描述了一名35岁、孕1产0、妊娠24周零3天的患者，既往无重大病史，出现左下肢水肿和变色，并伴有左腹股沟疼痛。这些症状出现在三天的腰痛放射至同一区域之后。体格检查结果提示深静脉血栓形成（DVT）。床旁超声和静脉多普勒检查证实血栓从左股静脉近端延伸至左髂外静脉。为进一步评估血栓负荷和解剖范围，在获得知情同意后进行了计算机断层扫描（CT）静脉造影。CT静脉造影显示血栓从左髂外静脉经左髂总静脉延伸至其与下腔静脉（IVC）的交界处。左髂总静脉明显受到上方右髂总动脉的压迫，导致静脉逆行性充血，支持继发于May-Thurner综合征的髂股DVT诊断。经过全面的多学科讨论和风险效益评估，并在患者知情同意后，采取了介入治疗方法。初始治疗包括使用依诺肝素抗凝、部分机械性血栓切除术和放置下腔静脉滤器。术后第二天，患者出现水肿急性加重、皮肤逐渐变色、患肢温度降低以及可触及脉搏减弱，引发了对与股青肿一致的动脉受累的担忧。对此，迅速进行了广泛的机械性血栓切除术，从而改善了远端静脉流出并实现了临床稳定。本病例表明，在选定的患有广泛或复杂髂股DVT的孕妇中，在多学科护理框架内进行机械性血栓切除术可以是一种安全有效的治疗选择，能够快速缓解症状并可能减少短期和长期并发症。
