Jayakrishna Gollamudi MD, Presenter: Nothing to Disclose

Kamlesh Uttamchand Kukreja MD, Abstract Co-Author: Nothing to Disclose

Ross Louis Ristagno MD, Abstract Co-Author: Nothing to Disclose

The overall incidence of deep venous thrombosis (DVT) in pediatric patients during hospital admissions were estimated 5.3-9.7 per 10,000 admissions. The current mainstay of treatment of acute is pharmacologic anticoagulation therapy, which only prevents further clot propagation but does not directly lead to clot lysis. Long term complications of DVT include extremity edema, hyperpigmentation, pain and ulceration. The most important prognostic factor in preventing development of post thrombotic syndrome was patency and competency of distal veins. This study examines the use of invasive method, including pharmacologic and mechanical thrombolysis, to treat deep venous thrombosis in the pediatric population at Cincinnati Children’s Hospital Medical Center over the last 3 years.

A retrospective chart review was performed to collect data on indication for the procedure, details of the procedure, result of the thrombolysis procedure and follow-up.

Data was collected on ten patients, age ranging from 4- 18 years (mean 14), over the three year period. Nineteen thrombolysis procedures were performed on ten patients. Angiojet Thrombectomy System (MedRad, Warrendale, PA) was used in twelve procedures in eight of the patients (80%). Stents had to be placed in two patients. Thrombolysis was initially successful in nine (90%) of the patients. Six patients (60%) had both clinical and imaging resolution on follow-up. Two patients had follow up at different institutions. There were no major bleeding complications.

The role of using invasive techniques to treat DVT is not as well defined in children as it is in adults. The limited results of this study and those of cases from other institutions are promising. Selective use of catheter directed therapy would be beneficial. A multicenter trial would be helpful in further defining the role of invasive methods of thrombolysis in pediatric patients with DVT.

Invasive methods of treating deep venous thrombosis in children is safe and can be potentially very beneficial.

Gollamudi, J, Kukreja, K, Ristagno, R, Treatment of Deep Venous Thrombosis in Children with Mechanical and Catheter Directed Thrombolysis.  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9003003.html