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

• Published in: Journal of vascular and interventional radiology Vol. 22; no. 2; pp. 121 - 132
• Main Authors: Goldenberg, Neil A., Branchford, Brian, Wang, Michael, Ray, Charles, Durham, Janette D., Manco-Johnson, Marilyn J.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2011
• Subjects: Adolescent; Child; Colorado - epidemiology; Combined Modality Therapy - statistics & numerical data; Embolization, Therapeutic - instrumentation; Embolization, Therapeutic - statistics & numerical data; Female; Fibrinolytic Agents - therapeutic use; Humans; Leg - blood supply; Male; Prevalence; Radiology; Risk Assessment; Risk Factors; Tissue Plasminogen Activator - therapeutic use; Treatment Outcome; Venous Thrombosis - epidemiology; Venous Thrombosis - therapy; Young Adult; Colorado; RR; LMWH; PPMT; DVT; APS; TPA; PE; PMT; VTE; IVC; CTDI; PTS; catheter-directed thrombolytic infusion; percutaneous pharmacomechanical thrombolysis; tissue plasminogen activator; low molecular weight heparin; relative risk; inferior vena cava; deep vein thrombosis; postthrombotic syndrome; venous thromboembolism; antiphospholipid antibody syndrome; pulmonary embolism; percutaneous mechanical thrombolysis
• ISSN: 1051-0443; 1535-7732; 1535-7732
• DOI: 10.1016/j.jvir.2010.10.013

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. 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. 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 May–Thurner 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%. 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.