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 language | English (US) |
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Pages (from-to) | 121-132 |
Number of pages | 12 |
Journal | Journal of Vascular and Interventional Radiology |
Volume | 22 |
Issue number | 2 |
DOIs | |
State | Published - Feb 2011 |
Externally published | Yes |
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