RESULTS OF SURGICAL-TREATMENT OF PELVIC V EIN-THROMBOSIS IN PREGNANCY

We report the results of surgical treatment of iliofemoral vein thromb osis in 49 pregnant women in a seven years period. The patients mean a ge was 26,5 years (range 18-41 years). Isolated descending pelvic vein thrombosis (PVT) occured between the 20(th) and 36(th) week of pregna ncy and was located predominantly left sided. 89,8% of PVT developed i n the late period of I gestation: three cases of pelvic vein thrombosi s were diagnosed after vaginal delivery. An iliac vein spur in one pat ient and an AT-III deficiency in two cases were registered as addition al risk factors. After Venous catheter thrombectomy an arteriovenous f istula between the superficial femoral artery and the femoral vein was performed to increase blood now and velocity in the pelvic veins. Abd ominal delivery was performed simultaneously, if thrombosis occured af ter the 34(th) week of pregnancy. Late re-thrombosis was registered in 4 patients (9,0%) after a mean follow-up of 42 months. We have seen s ymptoms of mild, not life threatening pulmonary embolism in two patien ts on the first postoperative day (complication rate 4,0%). Re-occlusi on rate was high (3/5) after surgical thrombectomy carried out between the 20(th) and 26(th) week of gestation. Risk factors were an ATIII d eficiency in two cases and the continued compression syndrome of the p elvic Veins caused by the enlarging uterus. In the late period of gest ation surgical thrombectomy of PVT is the preferential method of treat ment in selected patients with good therapeutical results. The operati on reduces the risk of future Venous insufficiency and post-thrombotic syndrome in the young female patients.