Outcomes of iliac vein stents after pregnancy

Objective: Stenting is the first-line treatment for obstructive iliocaval lesions when intervention is required. The aim of the study was to evaluate iliocaval stent patency during and after pregnancy in women of reproductive age who became pregnant after stent placement. Methods: Female patients of reproductive age (18-45 years old) who underwent iliocaval stenting between May 2007 and March 2014 were identified from a three-center prospectively maintained database. Medical records were reviewed for demographics, baseline risk factors, operative data, and clinical follow-up to identify pregnancy and postpartum stent imaging. The primary end point was stent patency. Standard descriptive statistics were used. Results: There were 310 women of reproductive age who received iliocaval stenting; 12 were identified to have had at least one pregnancy after stenting. The mean age was 28 +/- 5 years. One patient received thrombolysis and stenting at 14 weeks of pregnancy for deep venous thrombosis (DVT) and May-Thurner syndrome, three for a previous postpartum DVT (2, 4, and 6 weeks postpartum), three for DVT before any pregnancy with a history of factor V Leiden, and the remaining five for unprovoked DVT. All stents were self-expanding with a diameter range of 14 to 16 mm. Mean time from stenting to pregnancy was 23.3 +/- 28 months. All patients had patent stents during pregnancy and were prescribed therapeutic low-molecular-weight heparin by their obstetrician. One had asymptomatic left-sided stent compression 1 year after her second delivery, treated with balloon dilation. At average follow-up of 61 +/- 56 months, all patients had patent stents with no ultrasound-identified structural damage or thrombosis. Conclusions: Pregnancy does not negatively affect the outcomes of iliocaval stents after lysis of DVT or May-Thurner syndrome. Iliocaval stenting is not contraindicated in women of reproductive age, although close clinical and ultrasound follow-up is warranted during and after pregnancy.