Abstract

We report 3 cases of retrievable IVC philtres in pregnancy and performed a systematic review of the literature to determine the indications, success and complications rates for these devices in pregnancy.

A literature search of PubMed and Medline was conducted using the terms IVC philtre and pregnancy.

In our unit, 2 women had peripartum pulmonary emboli (PE) and the third woman had an iliac vein thrombosis and recurrent antepartum haemorrhage. Insertion of philtres was uncomplicated but only one was retrieved post delivery.

A total of 48 patients were identified from 20 publications (51 including our patients). Indications for insertion included extensive deep vein thrombosis (DVT) (39), PE (7), recurrent thrombosis (1), contraindication to anticoagulation (1) and unknown (3). Complications at insertion occurred in 2 patients. Two philtres were not removed, one philtre was repositioned and outcome was unclear in 5. Therefore 37/40 were retrieved successfully (81%). Retrieval failed in 8 women because of failure to snare (2), tilting (4), fracture and migration of the device(1) and occlusion of the philtre with thrombus (1).

The incidence of failed retrieval of IVC philtres in pregnancy (18%) is at the higher end of the spectrum reported in the general population (0 – 22%). Careful consideration of the benefits and risks of IVC philtre placement in pregnancy is paramount and the patient needs to be informed that almost one in five philtres remain in situ with subsequent increased risk of post thrombotic syndrome.