title: Endovascular venous thrombolysis in children younger than 24 months.
abstract: OBJECTIVE
  To evaluate the technical feasibility and safety of percutaneous endovascular thrombolysis for extremity deep venous thrombosis (DVT) in children < 24 months old.
  
  
  METHODS
  A retrospective chart review of a clinical and imaging database was performed for pediatric patients who underwent endovascular therapy for DVT between January 2010 and July 2013. Indications, techniques, technical and clinical success, and complications were reviewed. Techniques for thrombolysis included catheter-directed therapy (CDT) using alteplase infusion via a multi-side hole catheter, mechanical thrombectomy, and angioplasty. Short-term outcomes were assessed using surgical and imaging follow-up examinations for patency of the targeted vessel. Patients included 11 children (mean age, 9 mo; range, 3 wk-23 mo) who consecutively underwent endovascular thrombolysis for upper extremity (n = 6) or lower extremity (n = 5) DVT. The most common indication was preservation of venous access for future cardiac surgery or medical therapy.
  
  
  RESULTS
  The most common risk factor was the presence of a central venous catheter (10 of 11 patients). All patients with upper extremity DVT had congenital heart disease. CDT and angioplasty were performed in all patients. Venous patency was established in all patients. A grade III (95%-100%) thrombolysis response was achieved in seven patients, and a grade II (50%-95%) thrombolysis response was achieved in four patients. A major complication of pulmonary embolism occurred in one patient with upper extremity thrombolysis and was managed by intravenous systemic alteplase and heparin. No recurrence of thrombosis was found on average follow-up of 11.8 months (range, 1-41 mo).
  
  
  CONCLUSIONS
  Percutaneous endovascular thrombolysis for extremity DVT is safe and technically feasible in children < 24 months old.
authors.affiliation: Department of Radiology, Baylor College of Medicine & Texas Children's Hospital, 6701 Fannin St, Suite 470, Houston, TX 77030. Electronic address: drkamleshkukreja@yahoo.com.
authors.forename: Kamlesh U
authors.initials: KU
authors.lastname: Kukreja
authors.affiliation: Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Matthew P
authors.initials: MP
authors.lastname: Lungren
authors.affiliation: Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Manish N
authors.initials: MN
authors.lastname: Patel
authors.affiliation: Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Neil D
authors.initials: ND
authors.lastname: Johnson
authors.affiliation: Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: John M
authors.initials: JM
authors.lastname: Racadio
authors.affiliation: Department of Radiology and Hematology & Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Christopher
authors.initials: C
authors.lastname: Dandoy
authors.affiliation: Department of Radiology and Hematology & Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Cristina
authors.initials: C
authors.lastname: Tarango
mesh_terms: D000367:Age Factors; D000800:Angioplasty, Balloon; D002406:Catheterization, Peripheral; D003131:Combined Modality Therapy; D057510:Endovascular Procedures / Q000009:adverse effects; D005240:Feasibility Studies; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007262:Infusions, Intravenous; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D010690:Phlebography; D012189:Retrospective Studies; D012307:Risk Factors; D017131:Thrombectomy; D015912:Thrombolytic Therapy / Q000009:adverse effects; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage* / Q000009:adverse effects; D016896:Treatment Outcome; D056824:Upper Extremity Deep Vein Thrombosis / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D014654:Vascular Patency; D020246:Venous Thrombosis / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator