A 28-year-old woman at 26 weeks and one day into her second pregnancy presented to our hospital with pain and swelling in her left leg which had started a few days before. Fetus vital signs were normal. Laboratory findings revealed D-dimer of 5.37 mg/L, and ultrasound demonstrated thrombus occluding the left femoral and external iliac vein. The patient was fitted with compression stockings and 6000 units of subcutaneous enoxaparin was initiated twice-daily. At 33 weeks and 5 days an endovascular venography was performed and a retrievable inferior vena cava filter deployed to minimize the risk of pulmonary embolism (PE) prior to and during the elective labor. Even if the inferior vena cava was compressed by the gravid uterus, an infrarenal filter was placed without complications. The procedure took 1 minute and 36 second of fluoroscopic time and exposed the fetus to a dose of 11 mGy. One week later the patient had a caesarean section and two weeks postdelivery the filter was retrieved by means of single access technique. She was discharged home and continued anticoagulation therapy with ultrasound follow-up for deep venous thrombosis. Inferior vena cava filter is mostly indicated in the acute treatment of a proximal deep venous thrombosis and/or PE in patients in whom anticoagulation therapy is contraindicated, such as during delivery, when it has to be stopped. In our experience this procedure was shown to be effective in pregnancy to prevent PE without significant fetal and maternal morbidity and with low dose exposure to the fetus.

Una donna di 28 anni alla 26^ settimana e un giorno della sua seconda gravidanza, giungeva presso il nostro ospedale lamentando da alcuni giorni dolore e gonfiore alla gamba sinistra. Normali i segni vitali del feto. I valori di laboratorio rilevavano D-dimero di 5,37 mg/L e l’indagine ecografica dimostrava trombosi della vena femorale e della vena iliaca esterna sinistra. La paziente veniva dotata di calze elastiche compressive e iniziava terapia anticoagulante. A 33 settimane e 5 giorni è stata eseguita venografia endovascolare e posizionato un filtro rimovibile in vena cava inferiore per minimizzare il rischio di embolia polmonare prima e durante il parto. Si è deciso di optare per il posizionamento in sede sotto-renale nonostante in quel tratto la vena fosse compressa dall’utero gravido. La procedura, conclusasi senza complicanze, ha richiesto 1 minuto e 36 secondi di fluoroscopia e il feto è stato esposto a una dose di 11 mGy. Una settimana dopo è avvenuto il parto con taglio cesareo in elezione, mentre il filtro è stato recuperato tre settimane dopo il suo posizionamento, con tecnica a singolo accesso. La principale indicazione per il posizionamento del filtro cavale è il trattamento acuto di una trombosi venosa profonda prossimale e/o embolia polmonare in pazienti con controindicazione assoluta alla terapia medica anticoagulante, ad esempio durante il parto, quando l’anticoagulante deve essere interrotto. Nella nostra esperienza questa procedura si è dimostrata essere una valida opzione in gravidanza, in quanto priva di significativa morbidità materno-fetale e con una bassa dose di radiazioni al feto.

Radiologia interventistica e gravidanza: filtro cavale rimovibile nel peripartum e dato dosimetrico fetale [Interventional radiology and pregnancy: retrievable inferior vena cava filter in the peripartum and dose fetus analysis]

Antonio VIZZUSO
Primo
Writing – Original Draft Preparation
;
Zairo FERRANTE
Secondo
Writing – Review & Editing
;
Graziano, Monica
Writing – Review & Editing
;
Sergio DALL’ARA
Investigation
;
Elisabetta SALVIATO
Penultimo
Investigation
;
Roberto GALEOTTI
Ultimo
Supervision
2019

Abstract

A 28-year-old woman at 26 weeks and one day into her second pregnancy presented to our hospital with pain and swelling in her left leg which had started a few days before. Fetus vital signs were normal. Laboratory findings revealed D-dimer of 5.37 mg/L, and ultrasound demonstrated thrombus occluding the left femoral and external iliac vein. The patient was fitted with compression stockings and 6000 units of subcutaneous enoxaparin was initiated twice-daily. At 33 weeks and 5 days an endovascular venography was performed and a retrievable inferior vena cava filter deployed to minimize the risk of pulmonary embolism (PE) prior to and during the elective labor. Even if the inferior vena cava was compressed by the gravid uterus, an infrarenal filter was placed without complications. The procedure took 1 minute and 36 second of fluoroscopic time and exposed the fetus to a dose of 11 mGy. One week later the patient had a caesarean section and two weeks postdelivery the filter was retrieved by means of single access technique. She was discharged home and continued anticoagulation therapy with ultrasound follow-up for deep venous thrombosis. Inferior vena cava filter is mostly indicated in the acute treatment of a proximal deep venous thrombosis and/or PE in patients in whom anticoagulation therapy is contraindicated, such as during delivery, when it has to be stopped. In our experience this procedure was shown to be effective in pregnancy to prevent PE without significant fetal and maternal morbidity and with low dose exposure to the fetus.
2019
Vizzuso, Antonio; Ferrante, Zairo; Graziano, Monica; Dall'Ara, Sergio; Salviato, Elisabetta; Galeotti, Roberto
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11392/2405584
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