title: Thrombus just beneath a retrievable inferior vena cava filter in a pregnant woman with deep vein thrombosis: its removal requiring catheter thrombus fragmentation with fibrinolysis.
abstract: Recently, transient inferior vena cava (IVC) filters have been employed to protect against pulmonary embolism (PE) in pregnant women with deep vein thrombosis. A 34-year-old primiparous Japanese woman with a history of myomectomy was diagnosed with deep vein thrombosis by ultrasound at 27 weeks of gestation. Unfractionated heparin was administered, which soon ameliorated swelling in the right thigh. A transient IVC filter was implanted just before cesarean section. An enhanced computed tomography scan 2 days after cesarean section revealed a wide thrombus just distal to the filter. We performed catheter thrombus fragmentation with fibrinolysis just before the removal of the IVC filter, resulting in re-canalization of blood flow. No significant PE occurred. Although a transient IVC filter may work well for the prophylaxis of PE during labor and delivery, catheter fragmentation with fibrinolysis may become necessary at removal of the filter.
authors.affiliation: Department of Obstetrics and Gynecology, Jichi Medical University School of Medicine, Shimotsuke-shi, Tochigi, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Horie
authors.forename: Hirotada
authors.initials: H
authors.lastname: Suzuki
authors.forename: Akihide
authors.initials: A
authors.lastname: Ohkuchi
authors.forename: Shigeki
authors.initials: S
authors.lastname: Matsubara
authors.forename: Tomokazu
authors.initials: T
authors.lastname: Ikemoto
authors.forename: Mitsuaki
authors.initials: M
authors.lastname: Suzuki
mesh_terms: D000328:Adult; D002405:Catheterization, Central Venous; D002585:Cesarean Section; D020878:Device Removal; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000628:therapy*; D011859:Radiography; D016306:Vena Cava Filters; D014682:Vena Cava, Inferior; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000628:therapy*
chemical_list: D005343:Fibrinolytic Agents; D006493:Heparin
keywords: catheter thrombus fragmentation; deep vein thrombosis; fibrinolysis; pregnancy; transient inferior vena cava filter