title: Pharmacomechanical catheter-directed thrombolysis for pregnancy-related iliofemoral deep vein thrombosis.
abstract: OBJECTIVE
  Pharmacomechanical catheter-directed thrombolysis (PCDT) is relatively contraindicated during pregnancy and postpartum. The purpose of this study was to evaluate outcomes of PCDT in this population.
  
  
  METHODS
  Data for 11 consecutive patients (aged 21-35 y) undergoing PCDT at a tertiary center for symptomatic pregnancy-related iliofemoral deep vein thrombosis (DVT) were retrospectively reviewed. Details regarding patient presentation, location and extent of thrombus, the PCDT procedure, outcomes, frequency of postthrombotic syndrome (PTS), and subsequent pregnancies were recorded. Two patients who presented in the first trimester terminated their pregnancies after PCDT, 2 patients who presented in the third trimester delayed PCDT until after delivery, and 7 patients who presented with postpartum DVT underwent immediate PCDT.
  
  
  RESULTS
  Thrombus extended into the inferior vena cava in 5 patients (45%) and into popliteal/tibial veins in 7 (64%). Four patients (36%) had synchronous pulmonary embolism and three had May-Thurner compression. Median interval from diagnosis to PCDT was 5 days (range, 2-68 d); median duration of urokinase infusion was 27 hours (range, 16-72 h). Greater than 90% clot lysis was achieved in 9 of 11 patients (82%). Metal stents were placed in 8 of 11 patients (73%). A self-limiting popliteal hematoma developed in 1 patient, and 2 had early recurrent thrombosis requiring repeat PCDT. At median 20-month follow-up, nonocclusive thrombus was seen in 5 patients. No patient developed PTS. Three patients, all with stents, had uneventful pregnancies after PCDT.
  
  
  CONCLUSIONS
  Pharmacomechanical catheter-directed thrombolysis achieved encouraging initial outcomes in this series. Validation in prospective trials with larger enrollment and longer follow-up is needed.
authors.affiliation: Departments of Radiology, Hadassah-Hebrew University Medical Center, P.O. Box 12000, Jerusalem, Israel 91120.. Electronic address: allan@hadassah.org.il.
authors.forename: Allan I
authors.initials: AI
authors.lastname: Bloom
authors.affiliation: Departments of Radiology, Hadassah-Hebrew University Medical Center, P.O. Box 12000, Jerusalem, Israel 91120.
authors.forename: Adam
authors.initials: A
authors.lastname: Farkas
authors.affiliation: Hematology, Hadassah-Hebrew University Medical Center, P.O. Box 12000, Jerusalem, Israel 91120.
authors.forename: Yossi
authors.initials: Y
authors.lastname: Kalish
authors.affiliation: Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, P.O. Box 12000, Jerusalem, Israel 91120.
authors.forename: Uriel
authors.initials: U
authors.lastname: Elchalal
authors.affiliation: Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, P.O. Box 12000, Jerusalem, Israel 91120.
authors.forename: Galia
authors.initials: G
authors.lastname: Spectre
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use; D002406:Catheterization, Peripheral / Q000009:adverse effects; D057510:Endovascular Procedures / Q000295:instrumentation; D005260:Female; D005268:Femoral Vein / Q000000981:diagnostic imaging; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007084:Iliac Vein / Q000000981:diagnostic imaging; D007262:Infusions, Intravenous; D062108:May-Thurner Syndrome / Q000175:diagnosis / Q000209:etiology; D061185:Mechanical Thrombolysis / Q000009:adverse effects / Q000379:methods*; D008670:Metals; D010690:Phlebography; D049590:Postpartum Period; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000175:diagnosis / Q000628:therapy*; D011261:Pregnancy Trimester, First; D011263:Pregnancy Trimester, Third; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage* / Q000009:adverse effects; D020246:Venous Thrombosis / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D055815:Young Adult
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents; D008670:Metals; D014568:Urokinase-Type Plasminogen Activator