CHICAGO, Illinois, March 2022 – A retrospective study reveals that iliac vein stents tolerate a gravid uterus well and that potential pregnancy should not contraindicate their usage in the treatment of pelvic venous insufficiency (PVI) also known as pelvic congestion syndrome.
According to principle author Peter Pappas, MD, from the Center for Vascular Medicine, “The standard of care for the treatment of chronic pelvic/leg pain secondary to PVI is iliac vein stenting with or without ovarian vein embolization. As many women receiving this therapy are of childbearing age, we assessed stent patency and re-intervention rates in women who became pregnant after undergoing iliac vein stenting.”
As reported in the March 2022 issue of the Journal of Vascular Surgery: Venous and Lymphatic Disorders, the researchers retrospectively reviewed prospectively collected data from their Office of the National Coordinator for Health Information Technology medical records for the years 2014-2020. This involved 23 centers in four states.
Two thousand forty six stents were placed in 1698 women during this time. From this cohort, 17 pregnancies in 15 women status post iliac vein stenting for PVI were studied.
Characteristics of the 15 patients included:
- Average age of 35 +/- 4 years,
- All were CEAP classification 0-3,
- 14 were non-thrombotic in nature, and
- Average time between stenting and pregnancy was 31 months.
Eleven of the 17 pregnancies were treated with enoxaparin during the pregnancy. None carried the diagnosis of hypercoagulability.
All patients underwent a post-partum ultrasound revealing no stent-related issues complicating any of the pregnancies.
Only one patient was lost to follow up, and in the remaining 16 pregnancies, no stent occlusions were observed at an average time of 43 +/- 24 months following the pregnancy.
Pappas comments, “A major unresolved question related to iliac vein stenting and pregnancy is in regard to the necessity of anticoagulation during and after pregnancy. The main indication for considering anticoagulation during and after pregnancy is the known increase in clotting factors during pregnancy, the increased incidence of venous thromboembolic events in pregnant women compare with non-pregnant women, and the fear of medical liability.”
Considering the general low risk for anticoagulation, it appears reasonable to anticoagulate pregnant patients with iliac stents who:
- Have a known hypercoaguable state,
- Underwent stenting for thrombotic disease, and
- Underwent stenting for non-thrombotic disease if low-risk for bleeding.
Only two other peer-reviewed publications covering this topic appear in the literature, and this study contains the largest number of patients. This important study adds significantly to the scarce literature on this important topic.
Center for Vascular Medicine – Jersey City
Dr. Peter Pappas
176 Palisade Ave. 4th floor