Endovascular venous thrombolysis in children younger than 24 months

Area of Science:

• Pediatric Cardiology
• Interventional Radiology
• Vascular Surgery

Background:

• Deep venous thrombosis (DVT) in children under 24 months presents unique challenges.
• Preservation of venous access is critical for medical therapy and cardiac surgery in this age group.
• Endovascular techniques offer minimally invasive options for treating pediatric DVT.

Purpose of the Study:

• To assess the technical feasibility of percutaneous endovascular thrombolysis for extremity DVT in children younger than 24 months.
• To evaluate the safety and efficacy of this treatment modality in a pediatric population.
• To determine short-term outcomes, including venous patency and complication rates.

Main Methods:

• Retrospective review of pediatric patients undergoing endovascular therapy for DVT (January 2010 - July 2013).
• Included techniques: catheter-directed therapy (CDT) with alteplase, mechanical thrombectomy, and angioplasty.
• Evaluated indications, procedural success, and complications, with follow-up for vessel patency.

Main Results:

• Eleven children (mean age 9 months) with upper or lower extremity DVT were treated.
• Central venous catheter presence was the most common risk factor; congenital heart disease was noted in upper extremity DVT cases.
• All patients achieved venous patency; a significant thrombolysis response (Grade II or III) was observed in all. One major complication (pulmonary embolism) occurred and was managed successfully. No recurrence was noted at a mean follow-up of 11.8 months.

Conclusions:

• Percutaneous endovascular thrombolysis is technically feasible for treating extremity DVT in children under 24 months.
• The procedure demonstrates a favorable safety profile in this young pediatric population.
• Successful restoration of venous patency suggests this approach is effective for pediatric DVT management.