Natural history of deep vein thrombosis in children.
OBJECTIVE
To determine the natural history of deep vein thrombosis in children presented with a first episode in the lower extremity veins.


METHODS
Children with objective diagnosis of acute deep vein thrombosis were followed up with ultrasound and clinical examination. Risk factors and clinical presentation were prospectively collected. The prevalence of recurrent deep vein thrombosis and the development of signs and symptoms of chronic venous disease were recorded.


RESULTS
There were 27 children, 15 males and 12 females, with acute deep vein thrombosis, with a mean age of 4 years, range 0.1-16 years. The median follow-up was 23 months, range 8-62 months. The location of thrombosis involved the iliac and common femoral vein in 18 patients and the femoral and popliteal veins in 9. Only one vein was affected in 7 children, two veins in 14 and more than two veins in 6. Recurrent deep vein thrombosis occurred in two patients, while no patient had a clinically significant pulmonary embolism. Signs and symptoms of chronic venous disease were present at last follow-up in 11 patients. There were nine patients with vein collaterals, but no patient developed varicose veins. Reflux was found in 18 veins of 11 patients. Failure of recanalization was seen in 7 patients and partial recanalization in 11. Iliofemoral thrombosis (p = 0.012) and failure to recanalize (p = 0.036) increased significantly the risk for developing signs and symptoms.


CONCLUSIONS
Children with acute proximal deep vein thrombosis develop mild chronic venous disease signs and symptoms at mid-term follow-up and are closely related with iliofemoral thrombosis and failure to recanalization.
Division of Vascular Surgery, Stony Brook University Medical Center, Stony Brook, New York, USA.
G
G
Spentzouris
Division of Vascular Surgery, Stony Brook University Medical Center, Stony Brook, New York, USA.
A
A
Gasparis
Section of Pediatric Surgery, Stony Brook University Medical Center, Stony Brook, New York, USA.
R J
RJ
Scriven
Section of Pediatric Surgery, Stony Brook University Medical Center, Stony Brook, New York, USA.
T K
TK
Lee
Division of Vascular Surgery, Stony Brook University Medical Center, Stony Brook, New York, USA nlabrop@yahoo.com.
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N
Labropoulos
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D012307:Risk Factors; D014463:Ultrasonography; D020246:Venous Thrombosis / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000628:therapy*
Deep vein thrombosis; venous thromboembolism; venous thromboembolism management