1
|
Moirano J, Khoury J, Yeisley C, Noor A, Voutsinas N. Interventional Radiology and Pregnancy: From Conception through Delivery and Beyond. Radiographics 2023; 43:e230029. [PMID: 37440450 DOI: 10.1148/rg.230029] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/15/2023]
Abstract
Interventional radiology (IR) plays a unique and often invaluable role in the care of pregnant patients. Special considerations regarding radiation exposure and medication choice must be taken into account when evaluating a pregnant patient for an interventional procedure. In addition, the physiologic changes that occur during pregnancy can pose special challenges for an interventionalist when treating this patient population and should be appropriately recognized. Still, the majority of standard IR procedures can be safely performed in the pregnant population, often with additional precautions and proper patient education about the risks, benefits, and alternatives. In many cases, interventional radiologists can provide lifesaving and fertility-preserving alternatives to more invasive surgical intervention. The authors summarize radiation exposure effects and guidelines and medication choice during pregnancy. The physiologic changes that occur during pregnancy are discussed, with specific interest in the pathologic consequences that can be treated with IR. The authors also describe a wide variety of minimally invasive image-guided procedures offered by IR in pregnant, peripartum, or postpartum patients. The areas where IR can help in the treatment of pregnant patients include venous access, biopsies, genitourinary and biliary interventions, venous thromboembolism treatments, ectopic pregnancy management, aneurysm intervention, and management of trauma patients. IR is also involved in management during the peripartum or postpartum periods, with roles in treatment of invasive placenta spectrum, postpartum hemorrhage after vaginal delivery, and postcesarean delivery complications. ©RSNA, 2023 Supplemental material is available for this article. Quiz questions for this article are available through the Online Learning Center.
Collapse
Affiliation(s)
- Joseph Moirano
- From the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 300 Community Dr, Manhasset, NY 11030 (J.M.); Department of Radiology, Division of Vascular and Interventional Radiology, Northwell Health, Manhasset, NY (J.K., C.Y.); Department of Radiology, Division of Vascular and Interventional Radiology, NYU Grossman School of Medicine, New York, NY (A.N.); and Department of Radiology and Radiologic Sciences, Division of Vascular and Interventional Radiology, Vanderbilt University School of Medicine, Nashville, Tenn (N.V.)
| | - Joe Khoury
- From the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 300 Community Dr, Manhasset, NY 11030 (J.M.); Department of Radiology, Division of Vascular and Interventional Radiology, Northwell Health, Manhasset, NY (J.K., C.Y.); Department of Radiology, Division of Vascular and Interventional Radiology, NYU Grossman School of Medicine, New York, NY (A.N.); and Department of Radiology and Radiologic Sciences, Division of Vascular and Interventional Radiology, Vanderbilt University School of Medicine, Nashville, Tenn (N.V.)
| | - Christopher Yeisley
- From the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 300 Community Dr, Manhasset, NY 11030 (J.M.); Department of Radiology, Division of Vascular and Interventional Radiology, Northwell Health, Manhasset, NY (J.K., C.Y.); Department of Radiology, Division of Vascular and Interventional Radiology, NYU Grossman School of Medicine, New York, NY (A.N.); and Department of Radiology and Radiologic Sciences, Division of Vascular and Interventional Radiology, Vanderbilt University School of Medicine, Nashville, Tenn (N.V.)
| | - Amir Noor
- From the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 300 Community Dr, Manhasset, NY 11030 (J.M.); Department of Radiology, Division of Vascular and Interventional Radiology, Northwell Health, Manhasset, NY (J.K., C.Y.); Department of Radiology, Division of Vascular and Interventional Radiology, NYU Grossman School of Medicine, New York, NY (A.N.); and Department of Radiology and Radiologic Sciences, Division of Vascular and Interventional Radiology, Vanderbilt University School of Medicine, Nashville, Tenn (N.V.)
| | - Nicholas Voutsinas
- From the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 300 Community Dr, Manhasset, NY 11030 (J.M.); Department of Radiology, Division of Vascular and Interventional Radiology, Northwell Health, Manhasset, NY (J.K., C.Y.); Department of Radiology, Division of Vascular and Interventional Radiology, NYU Grossman School of Medicine, New York, NY (A.N.); and Department of Radiology and Radiologic Sciences, Division of Vascular and Interventional Radiology, Vanderbilt University School of Medicine, Nashville, Tenn (N.V.)
| |
Collapse
|
2
|
Koudounas G, Giannopoulos S, Volteas P, Virvilis D. A unique case of hypoplastic inferior vena cava leading to bilateral iliofemoral venous outflow obstruction and review of literature. J Vasc Surg Cases Innov Tech 2022; 8:842-849. [PMID: 36561354 PMCID: PMC9763364 DOI: 10.1016/j.jvscit.2022.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 10/17/2022] [Indexed: 11/07/2022] Open
Abstract
Venous thromboembolism (VTE) is a common cardiovascular disease associated with high rates of morbidity and mortality whereas it induces substantial health care costs and increased use of resources. The current standard of treatment for acute deep vein thrombosis (DVT) is anticoagulation, although revascularization can be considered in younger patients with severe symptoms and extensive thrombus burden to prevent long-term sequalae of VTE (eg, recurrent DVTs, post-thrombotic syndrome post-pulmonary embolism syndrome, and chronic thromboembolic pulmonary hypertension). A rare cause of VTE is anomalous development of the inferior vena cava (IVC) and can challenge endovascular revascularization. This case report describes a case of hypoplastic supra hepatic IVC, associated with distal IVC occlusion and bilateral lower extremity DVTs treated successfully with suction thrombectomy and on table only thrombolysis, avoiding the higher risk for major bleeding, intensive care unit admission and prolonged hospitalization associated with prolonged tissue plasminogen activator infusion.
Collapse
Affiliation(s)
| | | | | | - Dimitrios Virvilis
- Correspondence: Dimitrios Virvilis, MD, Stony Brook University Hospital, 101 Nicolls Rd, Stony Brook, NY 11794
| |
Collapse
|
3
|
Lu ZX, Wei HL, Shi Y, Huang H, Su H, Chen L. Safety and Efficacy of Endovascular Treatment on Pregnancy-Related Iliofemoral Deep Vein Thrombosis. Clin Appl Thromb Hemost 2022; 28:10760296221124903. [PMID: 36083157 PMCID: PMC9465584 DOI: 10.1177/10760296221124903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: This study investigates the safety and efficacy of
endovascular treatments on pregnancy-related iliofemoral deep vein thrombosis
(DVT). Methods: We retrospectively reviewed data of 46 patients
who had symptomatic pregnancy-related iliofemoral DVT and underwent endovascular
treatment. The patients treated with catheter-directed thrombolysis (CDT) were
classified as the CDT group. In contrast, those treated with CDT combined with
pharmacomechanical thrombectomy (PMT) or angioplasty/stenting were classified as
the pharmacomechanical catheter-directed thrombolysis (PCDT) group.
Results: Based on the immediate post-operative clot burden
reduction rate analysis of 46 patients: 22 cases were completely dissolved
(lysis grades III), 12 were partially dissolved (lysis grades II), and 12 failed
(lysis grades I). There was a statistically significant difference in the rate
of clot burden reduction between the CDT group (n = 19) and the PCDT group
(n = 27) (p = 0.001). There was no statistically significant
difference in the number of bleeding events between the two groups
(p = 0.989). At 24 months, cumulative venous patency in the
CDT group was 50.0%, compared to 78.2% in the PCDT group. Furthermore, there was
a statistically significant difference in Villalta score
(p = 0.001) and venous severity scoring (VCSS score)
(p = 0.005) between the two groups.
Conclusions: CDT treatment combined with PMT or
angioplasty/stenting is comparatively safe and effective for pregnant-related
DVT patients. PCDT outperforms CDT in terms of immediate efficacy and reduces
the incidence of post-thrombotic syndrome with better midterm outcomes.
Collapse
Affiliation(s)
- Zhao-Xuan Lu
- Department of Vascular and Interventional Radiology, 385685Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Heng-Le Wei
- Department of Radiology, 579164The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, China
| | - Yadong Shi
- Department of Vascular and Interventional Radiology, 385685Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Hao Huang
- Department of Vascular and Interventional Radiology, 385685Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Haobo Su
- Department of Vascular and Interventional Radiology, 385685Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Liang Chen
- Department of Vascular and Interventional Radiology, 385685Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| |
Collapse
|
4
|
Ho VT, Dua A, Lavingia K, Rothenberg K, Rao C, Desai SS. Thrombolysis for Venous Thromboembolism During Pregnancy: A Literature Review. Vasc Endovascular Surg 2018; 52:527-534. [PMID: 29804522 DOI: 10.1177/1538574418777822] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Pregnancy is a hypercoagulable state, conferring an increased risk of venous thromboembolism (VTE). However, treatment algorithms for deep venous thrombosis and pulmonary embolism are based on studies of nonpregnant patients. METHODS A literature review of cases in which thrombolysis was used for the treatment of VTE during pregnancy was conducted using the PubMed (National Institutes of Health) database. RESULTS A PubMed database search of English language articles for reports of thrombolysis for the treatment of VTE in pregnancy identified 215 cases, including 183 cases of systemic thrombolysis, 19 cases of catheter-directed thrombolysis, and 13 cases of mechanical thrombectomy. For systemic thrombolysis, the maternal complication rate was 4.40% and the fetal complication rate was 1.65%. For catheter-directed thrombolysis, the maternal complication rate was 14.75% and the fetal complication rate was 5.2%. In cases of mechanical thrombectomy, there were no reported maternal or fetal complications. CONCLUSIONS Although conservative strategies are preferred in pregnancy, thrombolysis is an adjunct for limb or life-threatening VTE. Review of past reports suggests low rates of maternal and fetal complications following systemic thrombolysis and mechanical thrombectomy but higher rates of complications after catheter-directed thrombolysis in the treatment of VTE during pregnancy.
Collapse
Affiliation(s)
- Vy T Ho
- 1 Division of Vascular Surgery, Department of Surgery, Stanford Health Care, Stanford, CA, USA
| | - Anahita Dua
- 1 Division of Vascular Surgery, Department of Surgery, Stanford Health Care, Stanford, CA, USA
| | - Kedar Lavingia
- 1 Division of Vascular Surgery, Department of Surgery, Stanford Health Care, Stanford, CA, USA
| | - Kara Rothenberg
- 1 Division of Vascular Surgery, Department of Surgery, Stanford Health Care, Stanford, CA, USA.,2 Department of Surgery, University of California San Francisco-East Bay, San Francisco, CA, USA
| | - Christina Rao
- 3 Northwest Community Hospital, Arlington Heights, IL, USA
| | - Sapan S Desai
- 3 Northwest Community Hospital, Arlington Heights, IL, USA
| |
Collapse
|