title: Deep venous thrombosis during pregnancy and after delivery: indications for and results of thrombectomy.
abstract: OBJECTIVE
  Pregnancy and the puerperium are time periods of an increased risk for venous thromboembolism. An ideal treatment should lead to complete restoration of the venous lumen, elimination of the embolic source, and prevention of severe postphlebitic syndrome. Anticoagulation therapy with heparin or thrombectomy are treatment options. In the current literature, these options are discussed controversially.
  
  
  METHODS
  From January 1982 to December 2001, 97 women underwent (93% transfemoral) thrombectomy and construction of an arteriovenous fistula (AVF) for deep venous thrombosis related to pregnancy. The clinical and coagulation parameters were evaluated. The AVF was ligated 3 to 6 months later. Follow-up with duplex ultrasound scan, photoplethysmography, and strain-gauge plethysmography was completed in 87 women.
  
  
  RESULTS
  Surgery was performed without any maternal death or pulmonary embolization. A cesarean section was carried out during the same anesthesia in 11 cases. Thrombectomy was completed with construction of a temporary AVF in 90 patients (92.8%). One fetal death occurred in the recovery room for unknown reasons. In the early postoperative course, 16 patients (16.5%) underwent redo surgery for rethrombosis with or without the occlusion of the fistula. In 14 of these patients, the venous system remained patent thereafter. Fetal or neonatal death occurred in five cases 2 to 10 weeks after surgery, mainly because of abruption of the placenta probably from anticoagulation. Among 247 preoperatively occluded anatomic regions, 221 could be restored, and the secondary patency rate amounted to 89.5%. After a mean follow-up period of 6 years, 49 patients (56.3%) were seen without a postphlebitic syndrome, and only three patients (3.5%) had had a leg ulcer develop.
  
  
  CONCLUSIONS
  In experienced hands, venous thrombectomy is a safe method to prevent pulmonary embolism and postphlebitic syndrome in women during pregnancy and the puerperium. The frequency of a severe postphlebitic syndrome after our surgical approach is lower than the rates published for anticoagulation treatment alone.
authors.affiliation: Department of Vascular Surgery and Kidney Transplantation, Heinrich Heine University Medical Center, Moorenstrasse 5, 40225 Düsseldorf, Germany. Pillny@med.uni-duesseldorf.de
authors.forename: Michael
authors.initials: M
authors.lastname: Pillny
authors.forename: Wilhelm
authors.initials: W
authors.lastname: Sandmann
authors.forename: Bernd
authors.initials: B
authors.lastname: Luther
authors.forename: Barbara Th
authors.initials: BT
authors.lastname: Müller
authors.forename: Boris
authors.initials: B
authors.lastname: Tutschek
authors.forename: Andrea
authors.initials: A
authors.lastname: Gerhardt
authors.forename: Rainer B
authors.initials: RB
authors.lastname: Zotz
authors.forename: Rüdiger E
authors.initials: RE
authors.lastname: Scharf
mesh_terms: D000037:Abruptio Placentae / Q000209:etiology; D000293:Adolescent; D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use; D001166:Arteriovenous Shunt, Surgical; D002585:Cesarean Section; D005260:Female; D005313:Fetal Death; D006801:Humans; D007866:Leg / Q000098:blood supply; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000473:pathology / Q000601:surgery*; D011446:Prospective Studies; D011644:Puerperal Disorders / Q000473:pathology / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D017131:Thrombectomy / Q000009:adverse effects; D014682:Vena Cava, Inferior / Q000473:pathology; D020246:Venous Thrombosis / Q000473:pathology / Q000601:surgery*
chemical_list: D000925:Anticoagulants