David L. Lamar MD, PhD, Presenter: Nothing to Disclose

Giri Shivaram MD, Abstract Co-Author: Nothing to Disclose

Literature describing transcatheter portomesenteric thrombolysis in pediatric patients is lacking. The purpose of this study is to review our experience with catheter-directed thrombolysis in 8 children with a focus on etiology, presentation, and distribution of porrtomesenteric vein thrombosis and transcatheter thrombolysis technique, complications, and outcomes.

Retrospective analysis of 9 cases of catheter-directed portomesenteric vein thrombolysis in 8 patients (6 female, 2 male) performed at a pediatric academic referral-center. Mean age was 15.0 years old (range= 8 to 17 years old) at the time of initial interventions performed between 2005 and 2014. A presumed etiology was determined in 5 of 8 patients and included portal hypertension from various causes (3 patients), splenic torsion, and thrombocytosis following splenectomy for idiopathic thrombocytopenic purpura. No patients had hepatic transplants. For all patients, transhepatic portal access was achieved either via direct percutaneous or transjugular-transhepatic routes. Outcomes examined included resolution of symptoms, degree of lysis, complications, and sustained clot resolution at follow-up.

Successful transcatheter thrombolysis was achieved in 7 of 8 patients; one patient (unknown etiology of thrombus) experienced recurrent thrombus and eventual cavernous transformation. Two patients experienced major bleeding complications requiring transfusion (hemothorax and hemoperitoneum) which were successfully treated percutaneously. Three patients required TIPS shunt placement for portal hypertension at the time of PV thrombolysis or subsequent to initial therapy. No patients died or received hepatic transplants during the follow-up interval (mean= 2.3 years, median= 1.8 years, range= 0.1 to 8.5 years).

In our experience, percutaneous transhepatic catheter-directed thrombolysis in children is a safe and effective approach to address portomesenteric thrombosis from a variety of causes.

Use of catheter-directed portomesenteric thrombolysis in children is underreported and our experience suggests this minimally invasive therapy is a safe and effective approach.

Lamar, D, Shivaram, G, Clinical Outcomes in Pediatric Patients Who Underwent Catheter-Directed Portal and Mesenteric Vein Thrombolysis.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14007960.html