Page 4 - News VLU 08 2023

Vein & Lymphatic University
VLU voices

Deep Venous Thrombosis

During Pregnancy

Management, Considerations,
and Radiation Safety

Naishal Patel, MD; Nikki Keefe, MD

It is well known that preg- prevent PE in patients with ab-
nancy increases the risk solute contraindications to an-
for deep venous thrombo- ticoagulation. In cases of impai-
sis (DVT) due to a variety of red lower extremity perfusion,
physiologic changes, venous percutaneous catheter direc-
stasis and immobility resul- ted thrombolysis (PCDT) and
ting in hypercoagulability . thrombectomy is indicated, with
1–3
Although the risk of DVT is the use of thrombolytics taking
greatest in the first 12 weeks into account risks of placental
postpartum, it is also high in abruption, postpartum hemorr-
other stages of pregnancy, hage and impending delivery.
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especially in the late second Given the paucity of data on the
and third trimester . In addi- Nikki Keefe, MD risks of endovascular manage-
4,5
tion to more classic presenta- ment of DVT during pregnancy,
tions of calf vein DVT, there is it is important to have a multi-
a disproportionate number of left iliac and disciplinary discussion with the patient’s
iliofemoral DVT attributed to compression obstetrician to recommend the safest inter-
of the left iliac vein and/or inferior vena vention to the patient.
cava by the gravid uterus . Depending
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on severity of the patient’s presentation, For those patients who must undergo
interventionalists are increasingly called intervention, radiation should be limited as
upon to assist in management DVT during low as reasonably achievable to prevent
pregnancy. detrimental effects on the fetus. All efforts
should be made to limit radiation doses to
Treatment strategies for DVT during less than 100 mGy. 9,10 If the uterus is outsi-
pregnancy are controversial given the lack de the view of imaging field, then scattered
of data quantifying risks and benefits. The- radiation absorbed by the fetus is minimal.
re are unclear guidelines on treating distal Lead shielding during these procedures
DVT, however proximal DVT management has been suggested but may not be ne-
is similar to that in nonpregnant patients cessary given the low level of radiation
with added considerations. Therapeutic and concern for scatter. If imaging the ab-
anticoagulation with low molecular weight domen cannot be avoided, the procedura-
heparin is the mainstay of treatment in list should limit the field of view by collima-
the stable pregnant patient. Retrievable ting tightly. Proceduralists should always
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IVC filter placement can also be used to try to minimize radiation-heavy imaging
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