[Results of surgical treatment of pregnancy-associated pelvic vein thrombosis].

We report the results of surgical treatment of iliofemoral vein thrombosis in 49 pregnant women in a seven years period. The patients mean age was 26.5 years (range 18-41 years). Isolated descending pelvic vein thrombosis (PVT) occurred between the 20th and 36th week of pregnancy and was located predominantly left sided. 89.8% of PVT developed in the late period of gestation, three cases of pelvic vein thrombosis were diagnosed after vaginal delivery. An iliac vein spur in one patient and an AT-III deficiency in two cases were registered as additional risk factors. After venous catheter thrombectomy an arteriovenous fistula between the superficial femoral artery and the femoral vein was performed to increase blood flow and velocity in the pelvic veins. Abdominal delivery was performed simultaneously, if thrombosis occurred after the 34th week of pregnancy. Late re-thrombosis was registered in 4 patients (9.0%) after a mean follow-up of 42 months. We have seen symptoms of mild, not life threatening pulmonary embolism in two patients on the first postoperative day (complication rate 4.0%). Re-occlusion rate was high (3/5) after surgical thrombectomy carried out between the 20th and 26th week of gestation. Risk factors were an AT III deficiency in two cases and the continued compression syndrome of the pelvic veins caused by the enlarging uterus. In the late period of gestation surgical thrombectomy of PVT is the preferential method of treatment in selected patients with good therapeutical results. The operation reduces the risk of future venous insufficiency and post-thrombotic syndrome in the young female patients.