Catheter-Directed Thrombolysis for Thromboembolic Disease During Pregnancy: A Viable Option

Krishnamurthy, Parul; Martin, Chester B.; Kay, Helen H.; Diesner, Jane; Friday, Richard O.; Weber, Charles A.; Droste, Sabine

doi:10.3109/14767059909063149

Cited by 18 publications

(24 citation statements)

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“…They also stated that the risk of bleeding must be considered and thrombolytic therapy should only be administered under close observation. In a study by Krishnamurthy et al (11), a pregnant woman with PE, seriously ill, and two pregnant women with iliofemoral DVT who failed to respond to treatment with intravenous heparin were treated with catheter-directed urokinase. All three patients had fast symptom relief and successful pregnancy outcomes.…”

Section: Discussionmentioning

confidence: 99%

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Endovascular treatment of iliofemoral deep vein thrombosis in pregnancy using US-guided percutaneous aspiration thrombectomy

Gedikoglu¹,

Oğuzkurt²

2017

Diagn Interv Radiol

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P regnancy is a risk factor for venous thromboembolism (VTE) and the risk is highest in the postpartum period (1, 2). Anticoagulants are very effective in the prevention of pulmonary embolism (PE) and recurrent thrombosis, but the treatment of deep vein thrombosis (DVT) remains a challenge, because lysis of the thrombus formed in the deep veins is slow and frequently inadequate as a therapy (3, 4). Complete or significant lysis occurs only in 4% of patients treated with heparin alone (3). Persistence of thrombus within deep veins leads to venous hypertension, which is ultimately the cause of post-thrombotic syndrome (PTS) and late disability in 20% to 50% of patients. PTS is a conglomerate of lifestyle-limiting symptoms that commonly includes chronic leg pain and swelling, heaviness, and/or fatigue, venous claudication, stasis dermatitis, and in advanced cases skin ulcerations due to valvular incompetence accompanied by persistent venous outflow obstruction (4-8). Pregnant women are generally younger than other women in the general population, and they likely suffer a more severe form of PTS for a much longer time.Anticoagulants have been the standard therapy of DVT in pregnant women because of concerns related to administering contrast agent, exposing the fetus to radiation during interventional radiologic procedures, and bleeding complication associated with thrombolysis (9). Nonetheless, there are a few publications describing thrombolytic therapy of DVT with good success during pregnancy and peri-or postpartum period (10-13). In a previous study (14), a pregnant woman with DVT was treated using percutaneous mechanical thrombectomy under venographic guidance with contrast agent. Percutaneous aspiration thrombectomy (PAT) with or without fluoroscopy guidance in preg- 71From the Department of Radiology (M.G. 

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Section: Discussionmentioning

confidence: 99%

“…Nonetheless, there are a few publications describing thrombolytic therapy of DVT with good success during pregnancy and peri-or postpartum period (10)(11)(12)(13). In a previous study (14), a pregnant woman with DVT was treated using percutaneous mechanical thrombectomy under venographic guidance with contrast agent.…”

mentioning

confidence: 99%

Endovascular treatment of iliofemoral deep vein thrombosis in pregnancy using US-guided percutaneous aspiration thrombectomy

Gedikoglu¹,

Oğuzkurt²

2017

Diagn Interv Radiol

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“…Two case reports describe catheter directed thrombolysis during pregnancy with good success. 6,7 Likewise, in a small pilot study published in Denmark, five postpartum women with proximal DVTs underwent catheter-directed thrombolysis and experienced restoration of flow without complications. 5 A multi-center registry of 287 nonpregnant patients who underwent catheter-directed thrombolysis found an 11% rate of puncture site bleeding and 1% incidence of pulmonary embolus.…”

Section: Commentmentioning

confidence: 99%

May-Thurner Syndrome Resulting in Acute Iliofemoral Deep Vein Thrombosis in the Postpartum Period

Zander¹,

Staat²,

Galan³

2008

Obstetrics &Amp; Gynecology

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“…However, some case reports have been published recently describing thrombolytic treatment of DVT during pregnancy and postpartum. 3,4 The use of catheter-directed thrombolysis (CDT) of DVT may reduce long-term morbidity in these patients by restoring the patency of the veins. In these three cases, we report the efficacy and safety of ultrasound-accelerated catheter-directed thrombolysis (UACDT) for treating DVT during the postpartum period.…”

Section: Introductionmentioning

confidence: 99%

Endovascular treatment of postpartum deep venous thrombosis: report of three cases

Dumantepe¹,

Arif²,

Yurdakul³

et al. 2013

Vascular

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Pregnancy and the postpartum period are generally considered as contraindications for thrombolysis. We evaluate in this report the safety and effectiveness of using ultrasound-accelerated catheter-directed thrombolysis (UACDT) in treating three symptomatic postpartum deep vein thrombosis (DVT). UACDT was performed using a recombinant human tissue plasminogen activator (alteplase) which was delivered using the EKOS EkoSonic® system. Postprocedure venography was repeated after treatment which include stenting if stenosis was present. The treatment was successful in all three cases of iliofemoral DVT and symptom relief was achieved in all cases. Minor bleeding at the catheter insertion site in one patient was observed but none of the patients suffered from major bleeding or symptomatic pulmonary embolism. UACDT is a safe and effective treatment for restoration of the venous flow in patients with postpartum iliofemoral DVT. Residual venous obstruction should be treated by angioplasty and stent insertion to avoid early re-thrombosis.

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Catheter-Directed Thrombolysis for Thromboembolic Disease During Pregnancy: A Viable Option

Cited by 18 publications

References 0 publications

Endovascular treatment of iliofemoral deep vein thrombosis in pregnancy using US-guided percutaneous aspiration thrombectomy

Endovascular treatment of iliofemoral deep vein thrombosis in pregnancy using US-guided percutaneous aspiration thrombectomy

May-Thurner Syndrome Resulting in Acute Iliofemoral Deep Vein Thrombosis in the Postpartum Period

Endovascular treatment of postpartum deep venous thrombosis: report of three cases

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