Percutaneous Mechanical and Pharmacomechanical Thrombolysis for Occlusive Deep Venous Thrombosis of the Proximal Limb in Adolescents
Published Date:Jan 08 2011
Source:J Vasc Interv Radiol. 22(2):121-132.
Pubmed Central ID:PMC3058325
Funding:1K23HL084055/HL/NHLBI NIH HHS/United States
K23 HL084055/HL/NHLBI NIH HHS/United States
K23 HL084055-04/HL/NHLBI NIH HHS/United States
U01DD00016/DD/NCBDD CDC HHS/United States
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.
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%.
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.
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