Percutaneous Mechanical and Pharmacomechanical Thrombolysis for Occlusive Deep Venous Thrombosis of the Proximal Limb in Adolescents

Details

• Alternative Title:
  J Vasc Interv Radiol
• Personal Author:
  Goldenberg, Neil A. ; Branchford, Brian ; Wang, Michael ; Ray, Charles ; Durham, Janette D. ; Manco-Johnson, Marilyn J.
• Description:
  PURPOSE
  
  Young individuals with occlusive, proximal limb DVT who have acutely elevated plasma levels of factor VIII and D-dimer are at high risk for post-thrombotic syndrome (PTS) when treated with conventional anticoagulation alone. We sought to evaluate our experience with adjunctive percutaneous mechanical/pharmacomechanical thrombolysis (PMT/PPMT) in such patients.
  
  PATIENTS AND METHODS
  
  Among 95 children 11 to 21 years of age enrolled in a prospective cohort of venous thromboembolism between March 1, 2006 and November 1, 2009, 16 met eligibility criteria and underwent PMT/PPMT, typically with adjunctive catheter-directed thrombolytic infusion (CDTI) of tissue-type plasminogen activator given post-procedure.
  
  RESULTS
  
  Median age was 16 years (range: 11–19 years). Thirteen cases (81%) involved lower limbs. Underlying stenotic lesions were disclosed in 53%, with endovascular stents deployed in all cases of May-Thurner. There were no peri-procedural major bleeding events and one symptomatic pulmonary embolism. Technical success rate was 94%. Early (<30 days) locally recurrent DVT developed in 40%, of which 83% were successfully re-lysed. Late recurrent DVT rate (median follow-up duration: 14 months [range: 1–42 months]) was 27%. Cumulative incidence of physically and functionally significant PTS at 1–2 years was 13%.
  
  CONCLUSION
  
  This experience provides prospective evidence that PMT/PPMT with adjunctive CDTI can be used safely and effectively in adolescents with DVT at high risk for PTS.
  
  
• Subjects:
  Adolescent Child Colorado Combined Modality Therapy Embolization, Therapeutic Female Fibrinolytic Agents Humans Leg Male Prevalence Risk Assessment Risk Factors Tissue Plasminogen Activator Treatment Outcome Venous Thrombosis Young Adult

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• Source:
  J Vasc Interv Radiol. 22(2):121-132
• Pubmed ID:
  21216157
• Pubmed Central ID:
  PMC3058325
• Document Type:
  Journal Article
• Funding:
  K23 HL084055-04/HL/NHLBI NIH HHSUnited States/ ; 1K23HL084055/HL/NHLBI NIH HHSUnited States/ ; K23 HL084055/HL/NHLBI NIH HHSUnited States/ ; U01 DD000016/DD/NCBDD CDC HHSUnited States/ ; U01DD00016/DD/NCBDD CDC HHSUnited States/
• Volume:
  22
• Issue:
  2
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:0de6f2aae7fce321c2320cea7155b2082584b730ac3aeb72d4694b79bd917314
• Download URL:
  https://stacks.cdc.gov/view/cdc/33185/cdc_33185_DS1.pdf
• File Type:
  [PDF - 388.57 KB ]