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Long term complications of inferior vena cava thrombosis
M Häusler1, D Hübner, T Delhaas
1Department of Paediatrics, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074 Aachen, Germany. Haeusler@RWTH-Aachen.de
Insights
Pediatric inferior vena cava (IVC) thrombosis can lead to serious long-term venous disease, especially in extensive cases. Central venous catheters should be used cautiously to prevent this condition.
Area of Science:
- Vascular Surgery
- Pediatric Thrombosis
- Venous Disease Management
Background:
- Inferior vena cava (IVC) thrombosis in children is a significant clinical challenge.
- Identifying risk factors and long-term outcomes is crucial for effective management.
- Previous studies have not fully elucidated the long-term sequelae of pediatric IVC thrombosis.
Purpose of the Study:
- To evaluate the long-term outcomes of pediatric inferior vena cava (IVC) thrombosis.
- To assess the risk of persisting venous obstruction and associated complications.
- To inform the development of improved treatment strategies for pediatric IVC thrombosis.
Main Methods:
- A combined retrospective and prospective study design.
- Inclusion of infants and children diagnosed with IVC thrombosis between 1980 and 1999.
- Long-term follow-up for up to 18 years to assess outcomes.
Main Results:
- Forty pediatric patients with IVC thrombosis were analyzed.
- Limited IVC thrombosis showed favorable outcomes with no persisting caval obstruction.
- Extensive IVC thrombosis resulted in persisting venous obstruction in 17/21 patients, with complications like varicose veins and post-thrombotic syndrome.
Conclusions:
- Extensive pediatric IVC thrombosis carries a high risk of long-term venous disease and complications.
- Central venous catheters are implicated in a majority of cases and their use should be restricted.
- Prospective studies are essential to establish optimal treatment strategies and improve prognosis.
Aim:
To evaluate the long term outcome after paediatric inferior vena cava (IVC) thrombosis.
Methods:
A combined retrospective and prospective study on infants and children with IVC thrombosis treated at Aachen and Maastricht University Hospitals between 1980 and 1999.
Results:
Forty patients were enrolled, including four with preceding cardiac catheterisation, 18 with central venous saphenous lines, and an additional eight with umbilical venous catheters. Six patients died within three months of diagnosis; one patient was lost to follow up. Twelve of the remaining 33 patients had suffered from limited IVC thrombosis; during follow up (for up to nine years) none showed persisting caval obstruction (successful thrombolysis, n = 2; spontaneous recanalisation, n = 10). The remaining 21 patients presented with extensive IVC thrombosis. During follow up (for up to 18 years) complete restitution was found in only four cases (one thrombolysis, two surgery, one spontaneous recanalisation). Persisting iliac and/or caval venous obstruction occurred in 17 patients, including six with thrombolysis. Varicose veins were found in 12, and post-thrombotic syndrome in seven of these cases. According to Kaplan-Meier analysis, 30% of patients with persisting venous disease will develop post-thrombotic syndrome within 10 years of the thrombotic event.
Conclusions:
Infants and children with extensive IVC thrombosis are at high risk for persisting venous disease and serious long term complications. Prospective trials are urgently needed to establish effective treatment strategies and to improve long term prognosis. Central venous catheters, contributing to IVC thrombosis in the majority of cases reported here, should be inserted only if essential.