Surgical Treatment of Iliofemoral Vein Thrombosis in Pregnancy

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Abstract
The incidence of deep leg vein thrombosis in pregnancy is estimated at 0.13 per 1000 to 1.4 per 100.1−3 One-third occur as isolated, descending iliofemoral vein thromboses, predominantly left-sided. We report our surgical experiences in venous thrombectomy with arteriovenous fistula (AV-fistula) in the groin between the superficial femoral artery and femoral vein in 29 gravidae with a mean age of 27.5 years (range 19–41 years). Thrombosis occurred between the 20th and 36th week of pregnancy. 25 were antepartum two postpartum and two postsectionem. An iliac spur was seen once, as was an AT III deficiency. At the beginning of our series AV-fistula was not performed in three patients who all suffered from re-thrombosis after 24 h. Re-thrombectomy with an AV-fistula was performed successfully. Three of the 26 gravidae with AV-fistula also developed re-thrombosis. In two patients re-thrombectomy was successful, in the third patient the common iliac vein could not be re-opened by thrombectomy and the functioning AF-fistula had been ligated because extensive vulval oedema had developed. Asymptomatic, late re-thrombosis occurred in two patients who were seen at outpatient follow-up. We have seen one mild, non-life-threatening pulmonary embolism on the first postoperative day. No further intraoperative nor postoperative or postpartum complications developed. The re-occlusion rate is 10.3% (3/29), the complication rate is 6.9% (2/29).