BMJ Case Reports 2018; doi:10.1136/bcr-2017-223105
  • Novel treatment (new drug/intervention; established drug/procedure in new situation)

Should catheter-directed thrombolysis be the standard of care for pregnancy-related iliofemoral deep vein thrombosis?

  1. Alexander Chapman2
  1. 1Radiology Department, St Peter’s Hospital, Chertsey, UK
  2. 2Radiology Department, St Peter’s Hospital, Chertsey, UK
  1. Correspondence to Dr Tze Hung Siah, tzehungsiah{at}
  • Accepted 10 February 2018
  • Published 27 February 2018


A 33-year-old, 8-week pregnant woman presented with mottling, pain and swelling of her left leg. Ultrasound Doppler scan revealed a large left iliofemoral deep vein thrombosis and the patient was diagnosed with phlegmasia cerulea dolens. After 24 hours of treatment with unfractionated heparin, there were minimal improvements in her symptoms. Catheter-directed thrombolysis was performed, following multidisciplinary consultation with the patient. An underlying May-Thurner lesion was identified and successfully stented. Radiation exposure to the fetus was minimised with the use of intravenous ultrasound and very low-dose fluoroscopy. Total radiation exposure to the fetus is 1.38 mGy, which is equivalent to 8 months of background radiation exposure. No immediate complication occurred and patient’s symptoms completely resolved. On further follow-up, her iliofemoral veins remained patent with good flow and there were no recurrence of symptoms. A healthy infant was successfully delivered at 40 weeks gestation.


  • Contributors THS: drafted the case report, research and review of current evidence. AC: revised the article, research and review of current evidence.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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