Transcatheter Management of Congenital and Acquired Venous Lesions in Children

Background: Congenital and acquired venous abnormalities in children represent a heterogeneous group of conditions associated with significant clinical morbidity, including systemic desaturation, hepatic dysfunction, and life-threatening hemodynamic compromise. Evidence regarding transcatheter management across this diverse spectrum remains limited and largely confined to small, lesion-specific series. This study aimed to evaluate the feasibility, procedural, and clinical outcomes of transcatheter venous interventions in a heterogeneous pediatric population. Methods: This retrospective single-center study included all consecutive pediatric patients (median age: 9 years; range: 2 days-17 years) who underwent a total of 28 transcatheter procedures for congenital and acquired venous abnormalities between January 2022 and September 2025. Lesions included congenital portosystemic shunts (n = 4), systemic venous stenoses (n = 2), obstructed pulmonary venous pathways (n = 3), and veno-venous collaterals or azygos/hemiazygos continuation associated with Glenn circulation (n = 9). Procedural strategies were tailored according to anatomical characteristics, and outcomes were assessed in terms of technical success, procedural complications, and lesion-specific clinical and hemodynamic improvement. Results: A total of 28 transcatheter procedures were performed in 18 patients. The median procedure duration was 120 min (range, 35-235 min), and the median follow-up duration was 13.5 months (range, 0.6-35 months). During follow-up, two patients required reintervention for restenosis of previously treated lesions, whereas five additional procedures were performed because of newly developed veno-venous collaterals. Transcatheter interventions resulted in lesion-specific clinical and hemodynamic improvements, including reductions in serum ammonia levels, relief of venous obstruction, and improvements in oxygen saturation. One patient with complex pulmonary venous obstruction died following subsequent surgery despite initial hemodynamic improvement. Conclusions: In this single-center experience, transcatheter venous interventions were feasible and were associated with favorable immediate and mid-term clinical and hemodynamic outcomes in children with diverse venous abnormalities. Given the small sample size, heterogeneous patient population, and retrospective design, these findings should be considered preliminary. Larger prospective multicenter studies are warranted to better define optimal patient selection, timing of intervention, and long-term outcomes.