Thrombectomy of acute iliofemoral venous thrombosis during pregnancy

Acute iliofemoral venous thrombosis is six times more frequent among pregnant than nonpregnant women. The disease is serious because of the risk of pulmonary embolism. The treatment of choice with regard to prevention of post-thrombotic disorders is controversial. Pregnant women represent a therapeutic problem because thrombolysis is hazardous to the fetus. We have performed thrombectomy and temporary arteriovenous fistula in combination with anticoagulant treatment upon all pregnant or recently pregnant women coming to our department with acute iliofemoral venous thrombosis from August 1985 to March 1987. In this period, eight pregnant women and one woman 12 days after cesarean section were admitted. This is an incidence of 0.83 per 1,000 deliveries. All of the women were evaluated with a mean follow-up time of 15 months. Six of nine patients were clinically asymptomatic. Six had a normal ambulatory strain gauge volumetry and seven, a normal occlusion strain gauge plethysmography. Two women delivered by cesarean section, one woman had an induced abortion because of the disease, two women delivered after partus provocatus and four delivered spontaneously. We conclude that thrombectomy and temporary arteriovenous fistula together with heparin is a safe treatment of acute iliofemoral venous thrombosis during pregnancy. There is no need to interrupt the pregnancies except for obstetric reasons.