Podcast summary
Iliofemoral DVT in Pregnancy: Save Limb, Protect Fetus
Phlegmasia in pregnancy demands immediate limb salvage judgment
Extensive DVT with cold, pulseless limb signals phlegmasia—venous outflow near-occlusion driving arterial compromise—so anticoagulation alone is insufficient; rapid OR-level intervention is time-critical despite pregnancy.
IVUS changes decisions by revealing residual compression
IVUS provides cross-sectional mapping of thrombus and vessel caliber, reducing radiation in pregnancy and uncovering remaining iliac compression (e.g., May-Thurner) even after mechanical clot removal.
Avoiding TPA shifts the thrombectomy risk tradeoff
When TPA is deferred in pregnancy to reduce maternal hemorrhage, mechanical strategies like clot retrieval become the primary tool, but they can still cause substantial blood loss and ongoing compartment/ischemia risks.
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