Hamostaseologie 2023; 43(02): 102-109
DOI: 10.1055/a-1701-2098
Review Article

Successful Secondary Endovascular Intervention in Pediatric Patients with Venous Thromboembolic Events

Hannah Glonnegger
1   Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Faculty of Medicine, Medical Center – University of Freiburg, Germany
,
Barbara Zieger
1   Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Faculty of Medicine, Medical Center – University of Freiburg, Germany
,
Jochen Grohmann
2   Department of Congenital Heart Defects and Pediatric Cardiology, Faculty of Medicine, University Heart Center Freiburg - Bad Krozingen, University of Freiburg, Freiburg im Breisgau, Germany
3   Department of Congenital Heart Disease/Pediatric Cardiology, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
,
Gabriele Freund
4   Department of Angiology, Faculty of Medicine, University Heart Center Freiburg - Bad Krozingen, University of Freiburg, Freiburg im Breisgau, Germany
,
Thomas Zeller
4   Department of Angiology, Faculty of Medicine, University Heart Center Freiburg - Bad Krozingen, University of Freiburg, Freiburg im Breisgau, Germany
,
Markus Uhl
5   Division of Pediatric Radiology, Department of Radiology, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
,
Brigitte Stiller
2   Department of Congenital Heart Defects and Pediatric Cardiology, Faculty of Medicine, University Heart Center Freiburg - Bad Krozingen, University of Freiburg, Freiburg im Breisgau, Germany
› Author Affiliations

Abstract

Background In the past, pediatric patients with venous thromboembolic events (VTE) were treated with low-molecular-weight heparin (LMWH) which was successful in around 70% of the cases. However, anticoagulation alone might not restore patency in all patients, and advanced therapeutic options to prevent postthrombotic syndrome are needed. During recent years, endovascular interventions have become a treatment option for pediatric patients with persistent thrombotic occlusion, not only in life- or limb-threatening VTE.

Methods We evaluated 12 consecutive patients (11–17 years) with newly diagnosed VTE being treated at our department during the last 4 years (2017–2020). In case follow-up examination showed persistent venoocclusion under anticoagulation, patients received secondary interventional therapy like recanalization, percutaneous transluminal angioplasty with or without catheter-directed thrombolysis, and stenting. Patients with no clinical signs of venoocclusion or regredient thrombosis in imaging examination received anticoagulation alone.

Results Six of 12 (50%) patients underwent catheter intervention. Median time from diagnosis to intervention was 4 months (0–12 months). Reintervention was necessary in one (8%) case and complete recanalization failed in one (8%) case. There were no major bleeding events or other major postinterventional complications, no acute or late local recurrence, and all patients reported clinical improvement after the procedure.

Conclusion If endovascular intervention is used in teenage patients with persistent symptomatic VTE, reduction of postthrombotic symptoms is possible, even if intervention is performed secondary to failure of anticoagulation. Multidisciplinary treatment decisions can be based on the clinical course and follow-up imaging.



Publication History

Received: 18 July 2021

Accepted: 18 November 2021

Article published online:
13 January 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
  • References

  • 1 Andrew M, David M, Adams M. et al. Venous thromboembolic complications (VTE) in children: first analyses of the Canadian Registry of VTE. Blood 1994; 83 (05) 1251-1257
  • 2 van Ommen CH, Heijboer H, Büller HR, Hirasing RA, Heijmans HS, Peters M. Venous thromboembolism in childhood: a prospective two-year registry in the Netherlands. J Pediatr 2001; 139 (05) 676-681
  • 3 Raffini L, Huang Y-S, Witmer C, Feudtner C. Dramatic increase in venous thromboembolism in children's hospitals in the United States from 2001 to 2007. Pediatrics 2009; 124 (04) 1001-1008
  • 4 Stubbs JM, Assareh H, Curnow J, Hitos K, Achat HM. Incidence of in-hospital and post-discharge diagnosed hospital-associated venous thromboembolism using linked administrative data. Intern Med J 2018; 48 (02) 157-165
  • 5 Zhang Z, Lei J, Shao X. et al; China Venous Thromboembolism Study Group. Trends in hospitalization and in-hospital mortality from VTE, 2007 to 2016, in China. Chest 2019; 155 (02) 342-353
  • 6 Mahajerin A, Betensky M, Goldenberg NA. Thrombosis in children: approach to anatomic risks, thrombophilia, prevention, and treatment. Hematol Oncol Clin North Am 2019; 33 (03) 439-453
  • 7 Lassandro G, Palmieri VV, Palladino V, Amoruso A, Faienza MF, Giordano P. Venous thromboembolism in children: from diagnosis to management. Int J Environ Res Public Health 2020;17(14):
  • 8 Spentzouris G, Scriven RJ, Lee TK, Labropoulos N. Pediatric venous thromboembolism in relation to adults. J Vasc Surg 2012; 55 (06) 1785-1793
  • 9 Massicotte P, Adams M, Marzinotto V, Brooker LA, Andrew M. Low-molecular-weight heparin in pediatric patients with thrombotic disease: a dose finding study. J Pediatr 1996; 128 (03) 313-318
  • 10 Monagle P, Chan AKC, Goldenberg NA. et al. Antithrombotic therapy in neonates and children: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141 (2, Suppl): e737S-e801S
  • 11 Monagle P, Chalmers E, Chan A. et al. Antithrombotic therapy in neonates and children: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th edition). Chest 2008; 133 (6, Suppl): 887S-968S
  • 12 Goldenberg NA, Donadini MP, Kahn SR. et al. Post-thrombotic syndrome in children: a systematic review of frequency of occurrence, validity of outcome measures, and prognostic factors. Haematologica 2010; 95 (11) 1952-1959
  • 13 Goldenberg NA, Branchford B, Wang M, Ray Jr C, Durham JD, Manco-Johnson MJ. Percutaneous mechanical and pharmacomechanical thrombolysis for occlusive deep vein thrombosis of the proximal limb in adolescent subjects: findings from an institution-based prospective inception cohort study of pediatric venous thromboembolism. J Vasc Interv Radiol 2011; 22 (02) 121-132
  • 14 Tarango C, Manco-Johnson MJ. Pediatric thrombolysis: a practical approach. Front Pediatr 2017; 5: 260-260
  • 15 Kearon C, Akl EA, Comerota AJ. et al. Antithrombotic therapy for VTE disease: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141 (2, Suppl): e419S-e496S
  • 16 Strijkers RHW, de Wolf MAF, Arnoldussen CWKP. et al. Venous in-stent thrombosis treated by ultrasound accelerated catheter directed thrombolysis. Eur J Vasc Endovasc Surg 2015; 49 (04) 440-447
  • 17 Zaghlool DS, Franz RW, Jenkins J. EkoSonic thrombolysis as a therapeutic adjunct in venous occlusive disease. Int J Angiol 2016; 25 (04) 203-209
  • 18 Albisetti M. Thrombolytic therapy in children. Thromb Res 2006; 118 (01) 95-105
  • 19 Yee DL, Chan AKC, Williams S, Goldenberg NA, Massicotte MP, Raffini LJ. Varied opinions on thrombolysis for venous thromboembolism in infants and children: findings from a survey of pediatric hematology-oncology specialists. Pediatr Blood Cancer 2009; 53 (06) 960-966
  • 20 Kuhle S, Koloshuk B, Marzinotto V. et al. A cross-sectional study evaluating post-thrombotic syndrome in children. Thromb Res 2003; 111 (4-5): 227-233
  • 21 Manco-Johnson MJ. Postthrombotic syndrome in children. Acta Haematol 2006; 115 (3-4): 207-213
  • 22 Dandoy CE, Kukreja KU, Gruppo RA, Patel MN, Tarango C. Outcomes in children with deep vein thrombosis managed with percutaneous endovascular thrombolysis. Pediatr Radiol 2015; 45 (05) 719-726
  • 23 Gaballah M, Shi J, Kukreja K. et al. Endovascular thrombolysis in the management of iliofemoral thrombosis in children: a multi-institutional experience. J Vasc Interv Radiol JVIR 2016; 27 (04) 524-530
  • 24 Goldenberg NA, Durham JD, Knapp-Clevenger R, Manco-Johnson MJ. A thrombolytic regimen for high-risk deep venous thrombosis may substantially reduce the risk of postthrombotic syndrome in children. Blood 2007; 110 (01) 45-53
  • 25 Darbari DS, Desai D, Arnaldez F. et al. Safety and efficacy of catheter directed thrombolysis in children with deep venous thrombosis. Br J Haematol 2012; 159 (03) 376-378
  • 26 Kelkar AH, Rajasekhar A. Inferior vena cava filters: a framework for evidence-based use. Hematol Am Soc Hematol Educ Program 2020; 2020 (01) 619-628
  • 27 Monagle P, Cuello CA, Augustine C. et al. American Society of Hematology 2018 Guidelines for management of venous thromboembolism: treatment of pediatric venous thromboembolism. Blood Adv 2018; 2 (22) 3292-316
  • 28 Jaff MR, McMurtry MS, Archer SL. et al. Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: a scientific statement from the American Heart Association. Circulation 2011; 123 (16) 1788-830
  • 29 Watson L, Broderick C, Armon MP. Thrombolysis for acute deep vein thrombosis. Cochrane Database Syst Rev 2016; 11 (11) CD002783
  • 30 Enden T, Kløw N-E, Sandvik L. et al. Catheter-directed thrombolysis vs. anticoagulant therapy alone in deep vein thrombosis: results of an open randomized, controlled trial reporting on short-term patency. J Thromb Haemost JTH 2009; 7 (08) 1268-1275