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Published on: June 2, 2015
Natural history of deep vein thrombosis in children
G Spentzouris1, A Gasparis1, R J Scriven2
1Division of Vascular Surgery, Stony Brook University Medical Center, Stony Brook, New York, USA.
Insights
Children with deep vein thrombosis (DVT) in leg veins can develop mild chronic venous disease. Iliofemoral DVT and poor recanalization significantly increase this risk, impacting long-term outcomes.
Area of Science:
- Pediatric vascular medicine
- Thrombosis research
- Venous disease epidemiology
Background:
- Deep vein thrombosis (DVT) in children is uncommon but can lead to long-term complications.
- Understanding the natural history of pediatric DVT is crucial for effective management and prognosis.
Purpose of the Study:
- To investigate the natural history of acute lower extremity deep vein thrombosis in children.
- To identify risk factors associated with the development of chronic venous disease after a first DVT episode.
Main Methods:
- Prospective follow-up of children diagnosed with acute lower extremity DVT using ultrasound and clinical examination.
- Collection of data on risk factors, clinical presentation, recurrent DVT, and chronic venous disease signs and symptoms.
Main Results:
- 27 children with acute DVT were followed for a median of 23 months.
- Iliofemoral DVT location and failure to recanalize were significantly associated with increased risk of chronic venous disease.
- Mild chronic venous disease signs and symptoms were observed in 11 patients, with reflux in 11 and failure of recanalization in 7.
Conclusions:
- Children experiencing acute proximal deep vein thrombosis may develop mild chronic venous disease in the mid-term.
- Iliofemoral thrombosis and impaired recanalization are key predictors of developing chronic venous disease after pediatric DVT.
Objective:
To determine the natural history of deep vein thrombosis in children presented with a first episode in the lower extremity veins.
Methods:
Children with objective diagnosis of acute deep vein thrombosis were followed up with ultrasound and clinical examination. Risk factors and clinical presentation were prospectively collected. The prevalence of recurrent deep vein thrombosis and the development of signs and symptoms of chronic venous disease were recorded.
Results:
There were 27 children, 15 males and 12 females, with acute deep vein thrombosis, with a mean age of 4 years, range 0.1-16 years. The median follow-up was 23 months, range 8-62 months. The location of thrombosis involved the iliac and common femoral vein in 18 patients and the femoral and popliteal veins in 9. Only one vein was affected in 7 children, two veins in 14 and more than two veins in 6. Recurrent deep vein thrombosis occurred in two patients, while no patient had a clinically significant pulmonary embolism. Signs and symptoms of chronic venous disease were present at last follow-up in 11 patients. There were nine patients with vein collaterals, but no patient developed varicose veins. Reflux was found in 18 veins of 11 patients. Failure of recanalization was seen in 7 patients and partial recanalization in 11. Iliofemoral thrombosis (p = 0.012) and failure to recanalize (p = 0.036) increased significantly the risk for developing signs and symptoms.
Conclusions:
Children with acute proximal deep vein thrombosis develop mild chronic venous disease signs and symptoms at mid-term follow-up and are closely related with iliofemoral thrombosis and failure to recanalization.
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