Study Evaluates Hemodynamic Effects of Pregnancy on the Lower Extremity Venous System

March 1, 2018—The Society for Vascular Surgery announced the publication of a new review of the literature on chronic venous insufficiency (CVI) in pregnant women that provides guidance for their treatment. The study was published by James Taylor, MBBChir, et al in Journal of Vascular Surgery: Venous and Lymphatic Disorders (2018;6:246–255).

According to the SVS, clinicians from Johns Hopkins Hospital and the Greater Baltimore Medical Center in Baltimore, Maryland, led by Jennifer Heller, MD, analyzed 80 studies related to pregnancy, venous thromboembolism (VTE), and CVI. The investigators provided a thorough review of VTE prevention and treatment during pregnancy (including indications for caval filters and management of iliofemoral thrombosis).

In the SVS press release, Dr. Heller commented, "It is important for physicians to comprehend the full extent of the hemodynamic factors that contribute to the increased risk of lower extremity venous disease as well as the most appropriate and effective evidence-based management options."

She continued, "While prophylaxis and treatment of VTE have been extensively studied in pregnancy, further research is required to look at the potential effectiveness and long-term safety profiles of new oral anticoagulants in the mother and fetus."

The SVS announcement noted that significant hemodynamic changes within the circulatory system that are considered essential for the health of the developing fetus but place considerable stress on the expectant mother's heart and lower extremity veins.

CVI occurs in up to 80% of pregnant women and approximately seven of every 1,000 pregnant women experience VTE and pulmonary embolism (PE). VTE, which is the leading cause of maternal death in developing countries, and PE affect pregnant women approximately five times more than nonpregnant women.

As summarized by SVS, the investigators surveyed the hemodynamic and physiologic changes caused by pregnancy, which include decreased systemic vascular resistance, increased heart rate, increased cardiac output, decreased deep venous blood flow, increased deep vein diameters, and a hypercoagulable state.

The investigators reviewed treatment strategies for primary CVI in pregnancy, including indications for nonpharmacologic therapies (ie, compression, reflexology, water emersion) and pharmacologic treatments (ie, anti-inflammatory drugs, fondaparinux, and low-molecular-weight heparin).

Dr. Heller hopes that future randomized trials will evaluate treatment strategies to relieve symptoms associated with CVI during pregnancy. Complete understanding of these issues helps physicians prepare their patients for these eventualities during pregnancy and treat venous complications effectively, reported the SVS.