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

Neil A. Goldenberg, Brian Branchford, Michael Wang, Charles Ray, Janette D. Durham, Marilyn J. Manco-Johnson

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose Young individuals with occlusive, proximal-limb deep vein thrombosis (DVT) who have acutely increased plasma levels of factor VIII and D-dimer are at high risk for postthrombotic syndrome (PTS) when treated with conventional anticoagulation alone. The present report is an evaluation of experience with adjunctive percutaneous mechanical thrombolysis (PMT) and/or percutaneous pharmacomechanical thrombolysis (PPMT) in such patients. Patients and Methods Among 95 children 11-21 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 after the procedure. Results Median age was 16 years (range, 11-19 y). Thirteen cases (81%) involved lower limbs. Underlying stenotic lesions were disclosed in 53%, with endovascular stents deployed in all cases of MayThurner anomaly. There were no periprocedural major bleeding events and one symptomatic pulmonary embolism. Technical success rate was 94%. Early (< 30 days) locally recurrent DVT developed in 40% of cases, of which 83% were successfully treated with repeat lysis. Late recurrent DVT rate (median follow-up duration, 14 months; range, 1-42 mo) was 27%. Cumulative incidence of physically and functionally significant PTS at 1-2 years was 13%. Conclusions This experience provides preliminary evidence that PMT/PPMT with adjunctive CDTI can be used safely and effectively in adolescent subjects with DVT at high risk for PTS.

Original languageEnglish (US)
Pages (from-to)121-132
Number of pages12
JournalJournal of Vascular and Interventional Radiology
Volume22
Issue number2
DOIs
StatePublished - Feb 2011
Externally publishedYes

Keywords

  • APS
  • Abbreviations
  • CTDI
  • DVT
  • IVC
  • LMWH
  • PE
  • PMT
  • PPMT
  • PTS
  • RR
  • TPA
  • VTE
  • antiphospholipid antibody syndrome
  • catheter-directed thrombolytic infusion
  • deep vein thrombosis
  • inferior vena cava
  • low molecular weight heparin
  • percutaneous mechanical thrombolysis
  • percutaneous pharmacomechanical thrombolysis
  • postthrombotic syndrome
  • pulmonary embolism
  • relative risk
  • tissue plasminogen activator
  • venous thromboembolism

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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