Thrombectomy For Ilio-Femoral Thrombosis In Fertile Women

Thirteen women, age 29-48 years, with iliofemoral venous thrombosis were subjected to thrombectomy via the femoral vein, and construction of an arteriovenous fistula. Anticoagulant therapy was given from the operation and 6 months on. The AV fistula was closed after 3 months. After cessation of anticoagulant therapy the patency of the iliac vein was evaluated by plethysmography and, if this was inconclusive, by phlebography. A work-up for coagulation abnormalities was also made.

All thromboses were left-sided. Several risk factors were present: pregnancy in 9 of 13 (2 early) contraceptive pills in 2 of 13, and iliac vein stenosis in 9 of 10. In 8 of 12 decreased levels of plasminogen activators were noted. Of the 9 pregnancies, three were complicated and required interruption, one was terminated by normal delivery one week before thrombectomy, two were interrupted at the time of thrombectomy, and three continued to normal deliveries several weeks after thrombectomy.

No pulmonary embolism was observed. At follow up, the iliac vein was patent in eleven patients. It is concluded that the pathogenesis of iliofemoral venous thrombosis in fertile women is multifactorial, involving hormonal and mechanical components. This study draws attention to decreased fibrinolytic activity in many of the patients. Thrombectomy resulted in iliac vein patency in eleven of thirteen patients. The procedure is well tolerated by mother and child during pregnancy.