title: Endovascular Thrombolysis in the Management of Iliofemoral Thrombosis in Children: A Multi-Institutional Experience.
abstract: OBJECTIVE
  To evaluate technical feasibility, complications, and clinical outcomes of endovascular thrombolysis for iliofemoral thrombosis at two tertiary-care children's hospitals.
  
  
  METHODS
  Institutional review board-approved retrospective review from March 2003 through June 2013 showed that venous thrombolysis for iliofemoral thrombosis was performed in 57 children (64 limbs) with a median age of 16.1 years (mean age, 14.5 y; range, 1.0-17.8 y). Techniques included catheter-directed thrombolysis (CDT), percutaneous mechanical thrombectomy (PMT), and pharmacomechanical catheter-directed thrombolysis (PCDT) with adjunctive angioplasty and/or stent placement. Villalta and modified Villalta scales were applied retrospectively to follow-up data to assess postthrombotic syndrome (PTS).
  
  
  RESULTS
  Technical success (≥ 50% thrombolysis) rate was 93.7%: grade III (100%) in 19 limbs, grade II (50%-99%) in 41 limbs, and grade I (< 50%) in four limbs. Techniques included CDT with PCDT (32.8%) or PMT (35.9%), CDT alone (26.6%), PCDT alone (4.7%) or with adjunctive angioplasty (54.7%), and stent placement (6.3%). Mean duration of CDT was 36.5 hours (range, 2.9-89.6 h). There was one major complication (1.8%) of bleeding requiring transfusion. Minor complications (ie, bleeding) occurred in seven patients (12.2%). Median follow-up was 1.5 years (range, 30 d to 7 y). Seven patients underwent repeat thrombolysis for recurrent thrombosis. The PTS rate was 59.3% per modified Villalta scale but only 2.1% per Villalta scale.
  
  
  CONCLUSIONS
  Endovascular thrombolysis is technically feasible and safe for iliofemoral thrombosis in children. Variable results were seen with two scales to assess PTS, suggesting an acute need for standardization of outcome measurement in children.
authors.affiliation: Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: Marian
authors.initials: M
authors.lastname: Gaballah
authors.affiliation: Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Junzi
authors.initials: J
authors.lastname: Shi
authors.affiliation: Department of Radiology, Texas Children's Hospital, 6621 Fannin St., Houston, TX 77030. Electronic address: drkamleshkukreja@yahoo.com.
authors.forename: Kamlesh
authors.initials: K
authors.lastname: Kukreja
authors.affiliation: Department of Hematology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: Leslie
authors.initials: L
authors.lastname: Raffini
authors.affiliation: Department of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Cristina
authors.initials: C
authors.lastname: Tarango
authors.affiliation: Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: Marc
authors.initials: M
authors.lastname: Keller
authors.affiliation: Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: Ganesh
authors.initials: G
authors.lastname: Krishnamurthy
authors.affiliation: Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: John
authors.initials: J
authors.lastname: Racadio
authors.affiliation: Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Manish
authors.initials: M
authors.lastname: Patel
authors.affiliation: Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: Anne Marie
authors.initials: AM
authors.lastname: Cahill
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D017130:Angioplasty; D002648:Child; D002675:Child, Preschool; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation; D005240:Feasibility Studies; D005260:Female; D005268:Femoral Vein / Q000000981:diagnostic imaging / Q000187:drug effects*; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D006776:Hospitals, Pediatric; D006801:Humans; D007084:Iliac Vein / Q000000981:diagnostic imaging / Q000187:drug effects*; D007223:Infant; D008297:Male; D008875:Middle Aged; D054070:Postthrombotic Syndrome / Q000209:etiology; D012008:Recurrence; D019233:Retreatment; D012189:Retrospective Studies; D015607:Stents; D062606:Tertiary Care Centers; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D020246:Venous Thrombosis / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy*; D055815:Young Adult
chemical_list: D005343:Fibrinolytic Agents