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Il Giornale Italiano di Radiologia Medica 2019 Gennaio-Febbraio;6(1):54-61

DOI: 10.23736/S2283-8376.19.00163-3

Copyright © 2019 EDIZIONI MINERVA MEDICA

language: English, Italian

Interventional radiology and pregnancy: retrievable inferior vena cava filter in the peripartum and dose fetus analysis

Antonio VIZZUSO 1 , Zairo FERRANTE 2, Monica GRAZIANO 1, Sergio DALL’ARA 3, Elisabetta SALVIATO 2, Roberto GALEOTTI 4

1 Specialization School in Radiodiagnostics, University of Ferrara, Ferrara, Italy; 2 Department of Hospital Radiology, University Hospital of Ferrara, Ferrara, Italy; 3 Department of Hospital Radiology, AUSL Ferrara, Ferrara, Italy; 4 Department of University Radiology, University Hospital of Ferrara, Ferrara, Italy


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A 28-year-old woman at 26 weeks and one day into her second pregnancy presented to our hospital with pain and swelling in her left leg which had started a few days before. Fetus vital signs were normal. Laboratory findings revealed D-dimer of 5.37 mg/L, and ultrasound demonstrated thrombus occluding the left femoral and external iliac vein. The patient was fitted with compression stockings and 6000 units of subcutaneous enoxaparin was initiated twice-daily. At 33 weeks and 5 days an endovascular venography was performed and a retrievable inferior vena cava filter deployed to minimize the risk of pulmonary embolism (PE) prior to and during the elective labor. Even if the inferior vena cava was compressed by the gravid uterus, an infrarenal filter was placed without complications. The procedure took 1 minute and 36 second of fluoroscopic time and exposed the fetus to a dose of 11 mGy. One week later the patient had a caesarean section and two weeks postdelivery the filter was retrieved by means of single access technique. She was discharged home and continued anticoagulation therapy with ultrasound follow-up for deep venous thrombosis. Inferior vena cava filter is mostly indicated in the acute treatment of a proximal deep venous thrombosis and/or PE in patients in whom anticoagulation therapy is contraindicated, such as during delivery, when it has to be stopped. In our experience this procedure was shown to be effective in pregnancy to prevent PE without significant fetal and maternal morbidity and with low dose exposure to the fetus.


KEY WORDS: Phlebography - Fetus - Vena cava filters

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