Aspiration Thrombectomy for Acute Deep Vein Thrombosis of the Left Lower Extremity of a Child after Cardiac Radiofrequency Ablation

Background: Deep vein thrombosis (DVT) of the lower extremity is rare in children and most of them or history of CVC placement. The therapy includes anticoagulation, systemic thrombolysis and, in rare cases, thrombectomy. Systemic thrombolysis with TPA has been used to treat patients who do not respond to anticoagulation and those with extensive DVT. Thrombo-aspiration with penumbra/Indigo System is a safe and effective treatment for adult patient with ALI, PE, and AVF thrombosis. We report of the case of an adolescent with DVT in the left lower extremity who underwent thrombo-aspiration with Indigo System. Method(s): A 14-year-old boy, with previous RFA for wolff-parkinson-white syndrome, with DVT of left popliteal, superficial, common femoral, and iliac veins not responding to anticoagulation underwent thrombo-aspiration with indigo system. After US-guided puncture of the popliteal vein, the dilator (3f) of a micropuncture set kit was positioned. An 0.018 guidewire was advanced along the venous axis, and the dilator was changed for an 8f sheath. Before starting the aspiration, a removable caval filter was positioned. Venography after the aspiration revealed partial recanalization of the left venous axis. Locoregional thrombolysis was performed with 0.6 mg of TPA. There were not complications during any phase of treatment. Anticoagulant therapy was administered. Result(s): One week after the procedure, the swelling of the left lower extremity had resolved completely. Caval filter was removed three months later. Duplex us at 1, 3 and 6 months confirmed recanalization of popliteal, common femoral and iliac veins and only residual thrombosis of the superficial femoral vein. The patient had no symptoms. Conclusion(s): DVT mechanical aspiration can be safe and effective to treat acute DVT of the lower extremity in older children and adolescents. Thrombo-aspiration before thrombolysis helps to decrease the thrombus burden, improve outflow for effective thrombolysis, and reduce the dose of thrombolytic required.

Publication History

Article published online:
11 May 2021