Thrombose und Gravidität : Möglichkeiten der operativen Behandlung

A case report illustrates the problematic clinical appearance of pregnancy-associated thrombosis of the inferior caval vein (ICV) and the deep iliacal and femoral veins (deep vein thrombosis, DVT). Uncertainties in therapy and medical management of these patients call for a broad interdisciplinary treatment consensus. Methods: After presenting the prevalence and genesis of DVT in pregnancy and the postpartal period the different options of treatment are critically discussed. Special emphasis is placed on surgical thrombectomy. Essential aspects are: atraumatic preparation of the deep veins, preventive blockage of the ICV and construction of arterio-venous fistulas to accelerate blood flow. Results: Maternal mortality was 0-1%. Fetal mortality increased over time from 1 to 5% mainly due to placental detachment. In duplex sonography 91% of the operated vessels were patent. Recurrent DVT was 9-16%,secondary patency rates were 88%, pulmonary embolism occurred in 3% of patients, another 3% suffered from pneumonia. Subsequently 36% of the women developed a mild postthrombotic syndrome during follow-up, 8% a severe one. Recurrent thrombosis occurred in 11 % of the cases. The highest thrombophilic risk was calculated for prothrombine mutations and in case of existence of Factor V Leiden. Conclusion: Surgical thrombectomy is a safe method for removal of blood clots in the ICV and the iliac veins. It yields good results in preventing lethal pulmonary embolism and severe postthrombotic syndrome, even during pregnancy and in the postpartal period. Patients at risk should be diagnosed early and treated with low molecular weight heparin.