Postpartum deep vein thrombosis resolved by catheter-directed thrombolysis: A case report

Iliac vein stenting and pregnancy

Venous stenting is the mainstay treatment of symptomatic iliofemoral venous outflow obstruction. However, because pregnancy and the postpartum period are hypercoagulable, concerns exist regarding stent placement in women of childbearing age. We performed a systematic review up to April 2023 of studies reporting on the performance of venous stents in women who subsequently became pregnant. The data collected included demographics, indication for stenting, stent characteristics, stent-related complications, incidence of venous thromboembolism, medical management during pregnancy, and follow-up. The indications for stenting included acute iliofemoral deep vein thrombosis in 39 patients (51%), nonthrombotic iliac vein lesions in 35 (46%), and post-thrombotic lesions in 2 patients. A total of 76 women with 87 subsequent pregnancies after stenting were included. Of the 76 women, 1 (1.14%) experienced stent occlusion, 2 (2.29%) developed asymptomatic nonocclusive in-stent thrombus, and 2 (2.29%) experienced permanent stent compression. The only patency loss occurred because of inadequate anticoagulation therapy in a patient with antiphospholipid antibodies. The two cases of permanent compression occurred in an arterial stent and a balloon-fenestrated Vici stent (Boston Scientific). Venous stents performed well through pregnancy and can be safely used in women of childbearing age. Given the increased risk of venous thromboembolism and the low bleeding risk, it is prudent to recommend anticoagulation therapy for all stented patients until more data are available.

Management of May Thurner Syndrome in Pregnant Patients

May Thurner Syndrome contributes to thromboembolic disease and can cause significant morbidity in pregnant patients secondary to exaggerated anatomic relationships and physiologic changes in the hematologic system favoring thrombogenesis. Because this condition is both underrecognized and underreported, management in pregnant and postpartum patients is based on expert opinion without any formal evidence-based guidance. Herein, we review five pregnancies in four patients with May Thurner Syndrome and general management strategies. Through collaborative and multidisciplinary care, patients with May Thurner Syndrome can be safely and successfully managed during pregnancy and the postpartum period with appropriate anticoagulation.