title: 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.
abstract: OBJECTIVE
  Young individuals with occlusive, proximal-limb deep vein thrombosis (DVT) who have acutely increased plasma levels of factor VIII and D-dimer are at high risk for postthrombotic syndrome (PTS) when treated with conventional anticoagulation alone. The present report is an evaluation of experience with adjunctive percutaneous mechanical thrombolysis (PMT) and/or percutaneous pharmacomechanical thrombolysis (PPMT) in such patients.
  
  
  METHODS
  Among 95 children 11-21 years of age enrolled in a prospective cohort of venous thromboembolism between March 1, 2006, and November 1, 2009, 16 met eligibility criteria and underwent PMT/PPMT, typically with adjunctive catheter-directed thrombolytic infusion (CDTI) of tissue-type plasminogen activator given after the procedure.
  
  
  RESULTS
  Median age was 16 years (range, 11-19 y). Thirteen cases (81%) involved lower limbs. Underlying stenotic lesions were disclosed in 53%, with endovascular stents deployed in all cases of May-Thurner anomaly. There were no periprocedural major bleeding events and one symptomatic pulmonary embolism. Technical success rate was 94%. Early (< 30 days) locally recurrent DVT developed in 40% of cases, of which 83% were successfully treated with repeat lysis. Late recurrent DVT rate (median follow-up duration, 14 months; range, 1-42 mo) was 27%. Cumulative incidence of physically and functionally significant PTS at 1-2 years was 13%.
  
  
  CONCLUSIONS
  This experience provides preliminary evidence that PMT/PPMT with adjunctive CDTI can be used safely and effectively in adolescent subjects with DVT at high risk for PTS.
authors.affiliation: Department of Pediatrics, Section of Hematology/Oncology/Bone Marrow Transplantation and Mountain States Regional Hemophilia and Thrombosis Center, University of Colorado, Aurora, Colorado 80045, USA. neil.goldenberg@ucdenver.edu
authors.forename: Neil A
authors.initials: NA
authors.lastname: Goldenberg
authors.forename: Brian
authors.initials: B
authors.lastname: Branchford
authors.forename: Michael
authors.initials: M
authors.lastname: Wang
authors.forename: Charles
authors.initials: C
authors.lastname: Ray
authors.forename: Janette D
authors.initials: JD
authors.lastname: Durham
authors.forename: Marilyn J
authors.initials: MJ
authors.lastname: Manco-Johnson
mesh_terms: D000293:Adolescent; D002648:Child; D003120:Colorado / Q000453:epidemiology; D003131:Combined Modality Therapy / Q000706:statistics & numerical data; D004621:Embolization, Therapeutic / Q000295:instrumentation* / Q000706:statistics & numerical data*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D007866:Leg / Q000098:blood supply; D008297:Male; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000453:epidemiology* / Q000628:therapy*; D055815:Young Adult
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator