410. Nitinol venous stent outcomes in peripartum women following treatment for acute ilio-femoral deep vein thrombosis

Introduction Deep vein thrombosis (DVT) is the leading cause of morbidity and mortality within pregnant and post-partum women. Contemporary management of acute ilio-femoral DVT includes catheter-directed thrombolysis and stenting of an obstructive lesion. Objective This study examines venous stent related outcomes of peripartum women (pregnant or within 6wks post-partum) with acute ilio-femoral DVT. Methods Peripartum women (2012–2017) treated for acute ilio-femoral DVT were included for analysis. Primary patency was defined as a patent stent with Results Of 190 patients treated for acute ilio-femoral DVT, 81 (43%) were women. Cumulative patency was 88% (median follow-up 2.3 yrs; range 30–328 wks). From this group, 9 women were peripartum (11%). Onset of DVT was post-partum for all (mean 4 wks after birth; range 3–6 wks). Two women were treated with catheter-directed thrombolysis alone, and 7 women were also stented. Median age at the time of stent placement was 29yrs (range 22–41 yrs). Primary, primary-assisted, and secondary patency rates were 14%, 43%, and 43%, respectively. Re-intervention was required in 6/7 (86%) peripartum women, with mean time to re-intervention of 9 wks (range 1–33 wks). Venous stenting in peripartum women was associated with a higher risk of re-intervention (HR 6.58; p = 0.0001, 95% CI [2.46, 17.60]), and was a strong predictor of cumulative patency loss (HR 10.71; p = 0.002, 95% CI [2.37, 48.51]). Discussion Peripartum women are significantly more likely to require re-intervention and experience patency loss compared with their non-peripartum counterpart. Thresholds for intervention may need to be higher and periprocedural anticoagulation strategies require more investigation if treatment is to be offered in the peripartum period.