Pregnancy in women with an inferior vena cava filter: a tertiary center experience and overview of literature

Background: Patients with an inferior vena cava (IVC) filter that remains in situ encounter a lifelong increased risk of deep vein thrombosis and IVC filter complications including fracture, perforation and IVC filter thrombotic occlusion. Data on the safety of becoming pregnant with an in situ IVC filter are scarce. Objective: To evaluate the risk of complications of in situ IVC filters during pregnancy. Methods: We performed a retrospective cohort study of pregnant patients with an in situ IVC filter from a tertiary center between 2000 and 2020. We collected data on complications of IVC filters and pregnancy outcomes. Additionally, we performed a systematic literature search in MEDLINE, Embase and grey literature. Findings: We identified seven pregnancies in four patients with in situ IVC filters with a mean time since IVC filter insertion of 3 years (range 1-8). No complications of IVC filter occurred during pregnancy. Review of literature yielded five studies including 13 pregnancies in nine patients. In one pregnancy a pre-existent, until then asymptomatic, chronic perforation of the vena cava wall by the IVC filter caused major bleeding and uterine trauma with fetal loss. Overall, the complication rate was 5%. Conclusion: It seems safe to become pregnant with an indwelling IVC filter that is intact and does not show signs of perforation, but due to the low number of cases no firm conclusions about safety of in situ IVC filters during pregnancy can be drawn. We suggest imaging prior to pregnancy to reveal asymptomatic IVC filter complications.

Vena Cava Filter Complications:

Vena cava filters (VCFs) have been employed at a rapidly growingpace over the last two decades.1,2 In fact, VCFs are placed in patientsin the United States at an estimated rate of 25 times that in Europe.3Likewise, the number of reported complications from VCFs alsohas increased significantly.1,4 The growing collection of literature onVCFs has led to an increased awareness of potential adverse outcomesafter filter insertion, and emphasis on appropriate preventionand treatment of these complications. We present an unusual case ofabdominal aortic pseudoaneurysm resulting from VCF perforationin a young patient who presented with hematemesis.