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Practice patterns in the management of pediatric iliofemoral arterial thrombosis
Alyssa E Vaughn1, Jessica K Hall1, Madison L Harrison1
1Division of Pediatric Surgery, Department of Surgery, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO.
Insights
Pediatric iliofemoral arterial thrombosis, mainly affecting infants, is effectively managed with anticoagulation like heparin or enoxaparin, rarely needing surgery. Shorter treatment courses (≤28 days) are safe and do not increase long-term risks.
Area of Science:
- Pediatric vascular medicine
- Hematology
- Interventional cardiology
Background:
- Acute arterial thrombosis poses significant life- and limb-threatening risks in children.
- Current pediatric iliofemoral arterial thrombosis management often relies on adult data due to limited expert consensus.
- Understanding pediatric-specific treatment patterns and outcomes is crucial for informed recommendations.
Purpose of the Study:
- To analyze treatment strategies and long-term outcomes in pediatric patients with acute iliofemoral arterial thrombosis.
- To compare outcomes between children receiving anticoagulation for ≤28 days versus >28 days.
- To inform evidence-based management guidelines for pediatric iliofemoral arterial thrombosis.
Main Methods:
- Retrospective study of 236 pediatric patients diagnosed with iliofemoral arterial thrombosis (2009-2018).
- Evaluation of management parameters, treatment duration (≤28 days vs. >28 days), and follow-up data.
- Statistical analysis using Fisher exact and Mann-Whitney U tests.
Main Results:
- The majority (207/236) of patients were infants; median treatment duration was 28 days.
- Longer treatment (>28 days) correlated with delayed thrombus resolution and more ultrasounds.
- No significant difference in limb length discrepancy; no peripheral arterial disease observed during follow-up. Common treatments included heparin bridged to enoxaparin (25.0%) and enoxaparin monotherapy (21.6%). Surgical intervention was rare (3.4%).
Conclusions:
- Pediatric iliofemoral arterial thrombosis is predominantly an infant condition managed effectively with anticoagulation (heparin/enoxaparin), with infrequent need for surgery.
- Anticoagulation courses of four weeks or less are safe when guided by ultrasound-confirmed thrombus resolution.
- This approach does not elevate the risk of surgical intervention or long-term complications.
Background:
Acute arterial thrombosis can be life- and limb-threatening. Most pediatric patients with iliofemoral arterial thrombosis are treated successfully with medical therapy; however, expert consensus is limited, and many recommendations are based on the extrapolation of adult data. We aim to understand treatment patterns and long-term outcomes after pediatric acute iliofemoral arterial thrombosis, from which management recommendations can be informed.
Methods:
A single-institution retrospective study of pediatric patients diagnosed with iliofemoral arterial thrombosis from 2009 to 2018 was performed. Multiple parameters of management and follow-up were evaluated. Children anticoagulated for ≤28 days versus >28 days were compared. Data analysis used Fisher exact and Mann-Whitney U tests.
Results:
Two hundred thirty-six children were included. Median age at diagnosis was 65 days (interquartile range 17-163), with 207 diagnosed as infants, 15 diagnosed between 1 to 2 years, and 14 diagnosed between 2 to 16 years. The median treatment duration was 28 days (interquartile range 13-42); patients treated for >28 days had a longer time for thrombus resolution, and more follow-up ultrasounds were performed. Limb length discrepancy did not differ between the groups (1.0% vs 6.3%, P = .06), and no patients were documented to have developed peripheral arterial disease over a median 6.5-year follow-up. Multiple treatment strategies were employed, the most common being heparin bridged to enoxaparin (25.0%) and enoxaparin monotherapy (21.6%). Eight patients (3.4%) underwent surgical intervention.
Conclusion:
Pediatric iliofemoral arterial thrombosis is primarily a disease of infants treated adequately with heparin or enoxaparin, infrequently requires surgical intervention, and is rarely associated with long-term complications. When guided by thrombus resolution on ultrasound, a four-week or shorter course of anticoagulation does not increase the need for surgical intervention or long-term complications.
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