妊娠中および産褥期の وإلى السفلي الوريدي فلتر (IVCF) の留置：単一施設での経験

Guidelines recommend placement of inferior vena cava filters (IVCF) in patients with acute proximal lower extremity deep vein thrombosis (DVT) and a contraindication to anticoagulation. IVCF placement during pregnancy or immediately postpartum presents technical challenges and is not extensively described in the existing literature.

To describe the use of IVCF in the obstetric population along with outcomes related to filter placement.

Retrospective chart review of all patients at Mayo Clinic from 2001-2020 with an IVCF at the time of conception or who underwent placement during pregnancy/postpartum.

24 pregnancies in 23 women (mean age 26.3 years, range 18-41) were included: 5 (21%) with IVCF placement prior to pregnancy, 7 (29%) during pregnancy, and 12 (50%) during postpartum. IVCF placed during pregnancy were frequently in the suprarenal position, in 5 (71%) cases. Meanwhile, 16 (94%) were deployed in an infrarenal position prior to pregnancy and postpartum. Complications included multiple attempts to remove the IVCF (n=2), severe angulation (n=4), embedded struts (n=3), fracture (n=1), and one case of cardiac tamponade (n=1). Complications were more common when placement was performed prior to pregnancy or during pregnancy (2, 40% and 4, 57% respectively) versus postpartum (2, 17%).

IVCF placement prior or during pregnancy/ postpartum is uncommon and is associated with a high incidence of complications, although most did not fundamentally impact clinical outcomes. While IVCF remain an option for clinicians treating pregnant and postpartum patients, these should be considered as a last resource.