title: Endovascular thrombolysis to salvage central venous access in children with catheter-associated upper extremity deep vein thrombosis: technique and initial results.
abstract: Nine patients (average age 8.3 years, range 20 days to 17 years; average weight 31 kg, range 2.7-79 kg) with catheter-associated UE-DVT underwent upper extremity venous thrombolysis with the goal of access salvage. Catheter directed therapy with alteplase (tPA), balloon angioplasty, and mechanical thrombectomy was used in all cases. The mean total dose of TPA was 15 mg (range 1-40 mg). Venous access was ultimately preserved in all patients. No stents or superior vena cava filters were used. There was one episode of symptomatic clinically suspected pulmonary embolism managed by systemic tPA and heparin without long term sequaele. Mean imaging and clinical follow-up was 351 ± 208 and 613 ± 498 days respectively. Endovenous thrombolysis for catheter-associated upper-extremity DVT in children may be safe and effective and could be considered particularly in patients in whom long-term venous access is needed.
authors.affiliation: Division of Pediatric Interventional Radiology, Department of Radiology, Lucile Packard Children's Hospital, Stanford University Medical Center, 725 Welch Road, Room 1675, Palo Alto, CA, 94305, USA, mlungren@stanford.edu.
authors.forename: Matthew P
authors.initials: MP
authors.lastname: Lungren
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Ward
authors.forename: Manish N
authors.initials: MN
authors.lastname: Patel
authors.forename: John M
authors.initials: JM
authors.lastname: Racadio
authors.forename: Kamlesh
authors.initials: K
authors.lastname: Kukreja
mesh_terms: D000293:Adolescent; D062905:Central Venous Catheters / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D061185:Mechanical Thrombolysis; D015912:Thrombolytic Therapy / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D020246:Venous Thrombosis / Q000209:etiology / Q000628:therapy*
chemical_list: D010959:Tissue Plasminogen Activator