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
| Autor: | Marilyn J. Manco-Johnson, Michael Wang, Janette D. Durham, Neil A. Goldenberg, Brian R. Branchford, Charles E. Ray |
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| Rok vydání: | 2011 |
| Předmět: |
Male
medicine.medical_specialty Colorado Adolescent medicine.drug_class Deep vein Low molecular weight heparin Risk Assessment Inferior vena cava Young Adult Fibrinolytic Agents Mechanical Thrombolysis Risk Factors Prevalence medicine Humans Radiology Nuclear Medicine and imaging Child Prospective cohort study Venous Thrombosis Leg business.industry medicine.disease Combined Modality Therapy Embolization Therapeutic Thrombosis Surgery Pulmonary embolism Venous thrombosis Treatment Outcome medicine.anatomical_structure medicine.vein Tissue Plasminogen Activator Female Radiology Cardiology and Cardiovascular Medicine business |
| Zdroj: | Journal of Vascular and Interventional Radiology. 22:121-132 |
| ISSN: | 1051-0443 |
| DOI: | 10.1016/j.jvir.2010.10.013 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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