Pulmonary Embolism due to Popliteal Vein Aneurysm during Pregnancy Induced by In Vitro Fertilization

Varetto, Gianfranco; Castagno, Claudio; Ripepi, Matteo; Bertoldo, U; Garneri, Paolo; Molinaro, Valentina; Quaglino, Simone; Rispoli, Pietro

doi:10.1016/j.avsg.2014.02.012

Cited by 3 publications

(6 citation statements)

References 11 publications

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“…Surgical options include aneurysmectomy with lateral venorrhaphy, resection and end-to-end anastamosis, resection and autologous or alloplastic graft interposition, and ligation of the proximal and distal vein 3,14 . Aneurysmectomy with lateral venorrhaphy to remove the source of embolism and maintain venous ow is the preferred approach based on technical feasibility and surgical success rates 3 .…”

Section: Discussionmentioning

confidence: 99%

“…There are few reports of PVA in pregnancy, which further complicated decision-making. In one report of a patient with PVA diagnosed in the setting of PE at 8 weeks gestational age in a pregnancy achieved by in vitro fertilization, medical management with LMWH was pursued for the duration of pregnancy based on patient preference 14 . Following delivery, she was maintained on warfarin while breastfeeding, and underwent surgical aneurysmectomy 7 months post-partum 14 .…”

Section: Discussionmentioning

confidence: 99%

“…In one report of a patient with PVA diagnosed in the setting of PE at 8 weeks gestational age in a pregnancy achieved by in vitro fertilization, medical management with LMWH was pursued for the duration of pregnancy based on patient preference 14 . Following delivery, she was maintained on warfarin while breastfeeding, and underwent surgical aneurysmectomy 7 months post-partum 14 . In another case of venous aneurysm in pregnancy, the patient elected to terminate her pregnancy and undergo surgical correction of her external iliac venous aneurysm 15 .…”

Section: Discussionmentioning

confidence: 99%

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Recurrent, life-threatening PE in the setting of popliteal vein aneurysm in pregnancy: A case report

McBride

Rannelli

Cantle

2023

Preprint

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Background Popliteal vein aneurysms (PVA) are a rare clinical entity with unknown etiology that pose a significant risk for venous thromboembolic events (VTE). The current literature supports anticoagulation and operative management. There are few case reports of PVA in pregnancy. We present a unique case of a pregnant patient with recurrent pulmonary embolism (PE) in the setting of PVA with intra-aneurysmal thrombosis who ultimately underwent surgical excision. Case presentation A previously healthy 34-year-old G2P1 at 30 weeks gestational age presented to the emergency department with shortness of breath and chest pain. She was diagnosed with PE and subsequently required intensive care unit (ICU) admission and thrombolysis for a massive PE. While on a therapeutic dose of tinzaparin she had recurrence of PE in the post-partum period. She was treated with supratherapeutic tinzaparin and subsequently transitioned to warfarin. She was found to have a PVA and ultimately underwent successful aneurysmorrhaphy. She remains on anticoagulation for secondary prevention of VTE. Conclusions PVA are a rare but potentially fatal source of VTE. Patients most commonly present with symptoms of PE. The risk of VTE is elevated in the pro-thrombotic states of pregnancy and the post-partum period due to both physiologic and anatomical changes. The recommended management of PVA with PE is anticoagulation and surgical resection of the aneurysm, however this can be complicated in the setting of pregnancy. We demonstrated that pregnant patients with PVA can be temporized with medical management to avoid surgical intervention during pregnancy, but require close symptom monitoring and serial imaging to reassess the PVA, with high index of suspicion for recurrent VTE. Ultimately, patients with PVA and PE should undergo surgical resection to reduce the risk of recurrence and long-term complications. The ideal duration of post-operative anticoagulation remains unclear, and should likely be decided on based on risks, benefits, values, and shared decision making with the patient and their care provider.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Recurrent, life-threatening PE in the setting of popliteal vein aneurysm in pregnancy: A case report

McBride

Rannelli

Cantle

2023

Preprint

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“…4 The risk of associated thrombosis is significant to the extent that anticoagulation, or even surgical correction, has been recommended for women with venous malformations undergoing IVF. 3 Further investigation is required to assess whether similar precautions should apply to those with risk factors for CVA and the benefit of screening women undergoing IVF for underlying arterial pathology. It may be necessary, for example, to inform women about these risks when consenting them for IVF.…”

Section: Discussionmentioning

confidence: 99%

“…2 The risk of thrombosis conveyed by venous aneurysms is such that IVF patients with such vascular malformations have been recommended antenatal anticoagulation or even prophylactic surgical correction. 3 Compared with venous thrombosis, however, less is known regarding the risk of arterial events such as cerebrovascular accidents (CVA) in this population.…”

Section: Introductionmentioning

confidence: 99%

Subarachnoid haemorrhage in pregnancy after in vitro fertilisation with egg donation: a case report and review of the literature

Hughes

Choudhury

Liyanage

et al. 2021

Clin Med�Insights�Reprod�Health

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We report a rare case of in vitro fertilisation (IVF) with egg donation complicated by a subarachnoid haemorrhage (SAH). Haemostatic changes related to IVF are known to increase risk of venous thrombosis; however, less is known regarding the risk of arterial events such as cerebrovascular accidents (CVA). Matrix metalloprotease-9 (MMP-9) upregulated in IVF patients may have a role in arterial aneurysm formation, which is the most common cause of SAH. Further research is required to assess the benefit of screening for risk of CVA and the best way to manage this in the IVF population. This may have implications for the ethics of offering certain procedures such as egg donation to women with pre-existing risk factors.

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Recurrent, life-threatening PE in the setting of popliteal vein aneurysm in pregnancy: a case report

2023

View full text Add to dashboard Cite

Background Popliteal vein aneurysms (PVA) are a rare clinical entity with unknown etiology that pose a significant risk for venous thromboembolic events (VTE). The current literature supports anticoagulation and operative management. There are few case reports of PVA in pregnancy. We present a unique case of a pregnant patient with recurrent pulmonary embolism (PE) in the setting of PVA with intra-aneurysmal thrombosis who ultimately underwent surgical excision. Case presentation A previously healthy 34-year-old G2P1 at 30 weeks gestation presented to the emergency department with shortness of breath and chest pain. She was diagnosed with PE and subsequently required intensive care unit (ICU) admission and thrombolysis for a massive PE. While on a therapeutic dose of tinzaparin she had recurrence of PE in the post-partum period. She was treated with supratherapeutic tinzaparin and subsequently transitioned to warfarin. She was found to have a PVA and ultimately underwent successful PVA ligation. She remains on anticoagulation for secondary prevention of VTE. Conclusions PVA are a rare but potentially fatal source of VTE. Patients most commonly present with symptoms of PE. The risk of VTE is elevated in the pro-thrombotic states of pregnancy and the post-partum period due to both physiologic and anatomical changes. The recommended management of PVA with PE is anticoagulation and surgical resection of the aneurysm, however this can be complicated in the setting of pregnancy. We demonstrated that pregnant patients with PVA can be temporized with medical management to avoid surgical intervention during pregnancy, but require close symptom monitoring and serial imaging to reassess the PVA, with high index of suspicion for recurrent VTE. Ultimately, patients with PVA and PE should undergo surgical resection to reduce the risk of recurrence and long-term complications. The ideal duration of post-operative anticoagulation remains unclear, and should likely be decided on based on risks, benefits, values, and shared decision making with the patient and their care provider.

show abstract

Pulmonary Embolism due to Popliteal Vein Aneurysm during Pregnancy Induced by In Vitro Fertilization

Cited by 3 publications

References 11 publications

Recurrent, life-threatening PE in the setting of popliteal vein aneurysm in pregnancy: A case report

Recurrent, life-threatening PE in the setting of popliteal vein aneurysm in pregnancy: A case report

Subarachnoid haemorrhage in pregnancy after in vitro fertilisation with egg donation: a case report and review of the literature

Recurrent, life-threatening PE in the setting of popliteal vein aneurysm in pregnancy: a case report

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