Endovascular Venous Thrombolysis in Children Younger than 24 Months |
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Institution: | 1. Department of Radiology, Baylor College of Medicine & Texas Children''s Hospital, 6701 Fannin St, Suite 470, Houston, TX 77030;2. Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio;3. Department of Radiology and Hematology & Oncology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio;1. Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo;2. Department of Radiology, North Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan;1. Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada;2. Diagnostic Imaging Department, St. Joseph’s Healthcare Hamilton, 50 Charlton Ave. E, Hamilton, ON, Canada L8N 4A6 |
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Abstract: | PurposeTo evaluate the technical feasibility and safety of percutaneous endovascular thrombolysis for extremity deep venous thrombosis (DVT) in children < 24 months old.Materials and MethodsA retrospective chart review of a clinical and imaging database was performed for pediatric patients who underwent endovascular therapy for DVT between January 2010 and July 2013. Indications, techniques, technical and clinical success, and complications were reviewed. Techniques for thrombolysis included catheter-directed therapy (CDT) using alteplase infusion via a multi–side hole catheter, mechanical thrombectomy, and angioplasty. Short-term outcomes were assessed using surgical and imaging follow-up examinations for patency of the targeted vessel. Patients included 11 children (mean age, 9 mo; range, 3 wk–23 mo) who consecutively underwent endovascular thrombolysis for upper extremity (n = 6) or lower extremity (n = 5) DVT. The most common indication was preservation of venous access for future cardiac surgery or medical therapy.ResultsThe most common risk factor was the presence of a central venous catheter (10 of 11 patients). All patients with upper extremity DVT had congenital heart disease. CDT and angioplasty were performed in all patients. Venous patency was established in all patients. A grade III (95%–100%) thrombolysis response was achieved in seven patients, and a grade II (50%–95%) thrombolysis response was achieved in four patients. A major complication of pulmonary embolism occurred in one patient with upper extremity thrombolysis and was managed by intravenous systemic alteplase and heparin. No recurrence of thrombosis was found on average follow-up of 11.8 months (range, 1–41 mo).ConclusionsPercutaneous endovascular thrombolysis for extremity DVT is safe and technically feasible in children < 24 months old. |
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Keywords: | CDT"} {"#name":"keyword" "$":{"id":"key0010"} "$$":[{"#name":"text" "_":"catheter-directed thrombolysis DVT"} {"#name":"keyword" "$":{"id":"key0020"} "$$":[{"#name":"text" "_":"deep venous thrombosis IVC"} {"#name":"keyword" "$":{"id":"key0030"} "$$":[{"#name":"text" "_":"inferior vena cava PE"} {"#name":"keyword" "$":{"id":"key0040"} "$$":[{"#name":"text" "_":"pulmonary embolism PMT"} {"#name":"keyword" "$":{"id":"key0050"} "$$":[{"#name":"text" "_":"pharmacomechanical thrombolysis |
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