Iliofemoral deep vein thrombosis in childhood; developing a management protocol.
OBJECTIVE
To develop an evidence-based protocol for the management of iliofemoral deep vein thrombosis (IDVT) in childhood.


METHODS
A search of the literature was undertaken. All publications pertaining to IDVT in childhood were analysed and then categorised according to their level of evidence. Recommendations were then made on the basis of this.


RESULTS
The commonest presenting symptoms were pain and swelling in the affected limb (evidence level II). Predisposing risk factors of special significance in children included the recent use of a venous access device, malignancy, prothrombotic disorders, infection, surgery and congenital venous anomalies (evidence level II). The most frequently described imaging modalities were B-mode ultrasonography, duplex, venography, and helical CT (evidence level III). The mainstay of treatment was anticoagulation with LMWH alone or followed by warfarin (evidence level I). Early clot removal through catheter-directed thrombolysis or surgical thrombectomy has been shown to be beneficial (evidence level II/III). There is little evidence for the benefit of early mobilisation and compression therapy in childhood.


CONCLUSIONS
Level I evidence relating to IDVT in childhood is sparse. The possibility of IDVT should be considered when examining a child with a swollen and painful limb. Imaging should be with duplex ultrasound, followed by spiral CT to include assessment of the IVC. A thrombophilia screen should be taken prior to anticoagulation with LMWH (and warfarin). Thrombolysis should be considered in cases of extensive IDVT.
Brightwell
R E
RE
Regional Vascular Unit, St Mary's Hospital, Praed Street, Paddington, London W2 1NY, UK. r.brightwell@imperial.ac.uk
Osman
I S
IS
D000465:Algorithms; D000925:Anticoagulants / Q000627:therapeutic use*; D002405:Catheterization, Central Venous / Q000009:adverse effects; D002648:Child; D005268:Femoral Vein / Q000000981:diagnostic imaging; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006493:Heparin / Q000627:therapeutic use; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006801:Humans; D007084:Iliac Vein / Q000000981:diagnostic imaging; D008297:Male; D017410:Practice Guidelines as Topic; D055502:Secondary Prevention; D017131:Thrombectomy; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D014463:Ultrasonography; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology
D000925:Anticoagulants; D005343:Fibrinolytic Agents; D006495:Heparin, Low-Molecular-Weight; D006493:Heparin; D010959:Tissue Plasminogen Activator