Endovascular Thrombolysis Studied to Treat Iliofemoral Thrombosis in Children

March 30, 2016—In the Journal of Vascular and Interventional Radiology (JVIR), Marian Gaballah, DO, et al published findings from a multi-institutional experience of endovascular thrombolysis for the management of iliofemoral thrombosis in children (2016;27:524–530). The study was conducted to evaluate technical feasibility, complications, and clinical outcomes of endovascular thrombolysis for iliofemoral thrombosis at two tertiary care children’s hospitals: Children’s Hospital of Philadelphia in Philadelphia, Pennsylvania, and Cincinnati Children’s Hospital Medical Center in Cincinnati, Ohio. 

The investigators concluded that endovascular thrombolysis is technically feasible and safe for iliofemoral thrombosis in children. Variable results were seen with two scales to assess postthrombotic syndrome (PTS), suggesting an acute need for standardization of outcome measurement in children, noted the investigators.

As summarized in JVIR, an institutional review board–approved retrospective review from March 2003 through June 2013 showed that venous thrombolysis for iliofemoral thrombosis was performed in 57 children (64 limbs) with a median age of 16.1 years. Techniques included catheter-directed thrombolysis (CDT), percutaneous mechanical thrombectomy (PMT), and pharmacomechanical catheter-directed thrombolysis (PCDT) with adjunctive angioplasty and/or stent placement. Villalta and modified Villalta scales were applied retrospectively to follow-up data to assess PTS.

The investigators found that the technical success (≥ 50% thrombolysis) rate was 93.7%: grade 3 (100%) in 19 limbs, grade 2 (50%–99%) in 41 limbs, and grade 1 (< 50%) in four limbs. Techniques included CDT with PCDT (32.8%) or PMT (35.9%), CDT alone (26.6%), PCDT alone (4.7%) or with adjunctive angioplasty (54.7%), and stent placement (6.3%). Mean duration of CDT was 36.5 hours. There was one major bleeding complication (1.8%) requiring transfusion. Minor bleeding complications occurred in seven patients (12.2%). Median follow-up was 1.5 years. Seven patients underwent repeat thrombolysis for recurrent thrombosis. The PTS rate was 59.3% per modified Villalta scale, but only 2.1% per Villalta scale, reported the investigators in JVIR.