McGriff S, Percer P, Sosa I, Mendez-Figueroa H, Mills JL, Gandhi M. When the Uterus Competes for Perfusion: Management of a Pregnant Patient with Bypass Graft Occlusion.
Case Rep Obstet Gynecol 2019;
2019:2432809. [PMID:
31687238 PMCID:
PMC6800891 DOI:
10.1155/2019/2432809]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 07/31/2019] [Accepted: 08/22/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND
Peripheral arterial disease (PAD) in pregnancy has serious implications and requires multidisciplinary management. This becomes even more complicated in the setting of active disease and history of prior vascular grafts.
CASE
A woman presented with increasing left lower extremity pain at 18 weeks of gestation with a complex history of PAD and a previous bifurcated aorta-left femoral, -right iliac bypass. CT angiogram demonstrated known occluded bypass graft. A multidisciplinary team of providers developed guidelines for potential surgical intervention based upon clinical symptoms.
CONCLUSION
Pelvic PAD can worsen in pregnancy in the setting of the enlarging uterus, which can potentially deplete perfusion of existing collateral vessels. Symptomatic approach to worsening disease provided an effective management strategy in this case.
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