Outcomes in children with deep vein thrombosis managed with percutaneous endovascular thrombolysis
- 362 Downloads
Our center has developed a multidisciplinary approach to percutaneous endovascular thrombolysis with the goal of improving outcomes in children with thrombosis. There is little data describing the safety and efficacy of endovascular thrombolysis and the frequency of post-thrombotic syndrome after thrombolysis in children.
Retrospective analysis of children undergoing percutaneous endovascular thrombolysis to determine (1) the safety and efficacy of this procedure and (2) the frequency of the diagnosis of post-thrombotic syndrome after thrombolysis.
Materials and methods
We reviewed the medical and imaging databases for children who underwent percutaneous endovascular thrombolysis for deep venous thrombosis (DVT) between November 2008 and June 2013 at our institution. Demographic data were reviewed for the technical success and complications of thrombolysis and the last assigned post-thrombotic syndrome score using standardized scoring tools.
Forty-one children ages 3 months to 21 years (median age: 15 years; 44% male) underwent percutaneous endovascular thrombolysis between November 2008 and June 2013. Upper extremity DVT occurred in 13 patients (32%); lower extremity DVT occurred in 28 patients (68%). All 41 patients received thrombolysis grading; 90% of those patients achieved greater than 50% thrombus lysis. Twenty-eight patients received formal post-thrombotic syndrome scoring and 4 (14%) met diagnostic criteria for post-thrombotic syndrome. One major bleeding episode and one pulmonary embolism occurred with no long-term sequelae.
Endovascular thrombolysis for DVT in children is safe, effective at thrombus removal and may reduce the incidence of post-thrombotic syndrome. Randomized or larger clinical trials would be needed to determine the long-term benefits of endovascular thrombolysis.
KeywordsDeep vein thrombosis Thrombolysis Catheter-directed thrombolysis Post-thrombotic syndrome Pharmacomechanical thrombolysis Children Adolescents Interventional radiology
We thank Anne Blackmore, MSN, MEd, RN, for her dedication and care of our thrombosis patients. Also, we thank Dr. John Racadio, Dr. Neil Johnson and the interventional radiology team at Cincinnati Children’s Hospital Medical Center.
Conflicts of interest
- 4.Chan AKC, Monagle P (2012) Updates in thrombosis in pediatrics: where are we after 20 years? ASH Educ Prog Book 2012:439–443Google Scholar
- 10.Goldenberg NA, Branchford B, Wang M et al (2011) Percutaneous mechanical and pharmacomechanical thrombolysis for occlusive deep vein thrombosis of the proximal limb in adolescent subjects: findings from an institution-based prospective inception cohort study of pediatric venous thromboembolism. J Vasc Interv Radiol 22:121–132CrossRefPubMedCentralPubMedGoogle Scholar
- 23.Villalta S, Bagatella P, Piccioli A et al. (1994) Assessment of validity and reproducibility of a clinical scale for the post-thrombotic syndrome. Haemostasis 24:158A (abstract)Google Scholar
- 30.Monagle P, Chan AKC, Goldenberg NA et al (2012) Antithrombotic therapy in neonates and children: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-based Clinical Practice Guidelines. Chest 141:e737S–e801SCrossRefPubMedCentralPubMedGoogle Scholar