Placement of a retrievable inferior vena cava filter for deep venous thrombosis in term pregnancy

Venous thromboembolism is a significant cause of morbidity and death in pregnant women. Retrievable vena cava filters were placed right before labor as prophylaxis for peripartum pulmonary embolism. We reviewed the experience of caval filter placement and retrieval in term pregnancy in this study.

We reviewed 15 patients with deep venous thrombosis (DVT) of the lower extremity who underwent OptEase (Cordis Corp, New Brunswick, NJ) retrievable vena cava filter placement. DVT was diagnosed by clinical symptoms and Doppler ultrasound imaging. Subcutaneous low-molecular-weight heparin was eased 12 hours before cesarean delivery and restarted 12 hours after delivery. The caval filters were placed suprarenally from the jugular approach and retrieved from the femoral approach.

The filters were successfully placed in all patients on the day of cesarean delivery. No placement-related complications occurred. The caval filter was left in situ as a permanent device in one patient because the captured thrombus within the filter was not eliminated after the thrombolytic therapy. Filters in other 14 patients were retrieved successfully, without difficulty, including in one patient after complete lysis of captured thrombus by the thrombolytic therapy. Oral warfarin therapy was recommended for at least 3 months after hospital discharge, and for at least 6 months in the patient with a caval filter left in situ. All patients were examined by Doppler ultrasound imaging during the follow-up. None presented with symptomatic pulmonary embolism or filter-related complications.

OptEase retrievable vena cava filter placement and retrieval in term pregnant patients with extensive DVT of the lower extremities is safe, effective, and feasible. The results in our study may justify prophylactic filter placement use right before labor.