Successful Secondary Endovascular Intervention in Pediatric Patients with Venous Thromboembolic Events

Abstract

Background In the past, pediatric patients with venous thromboembolic events (VTE) were treated with low-molecular-weight heparin (LMWH) which was successful in around 70% of the cases. However, anticoagulation alone might not restore patency in all patients, and advanced therapeutic options to prevent postthrombotic syndrome are needed. During recent years, endovascular interventions have become a treatment option for pediatric patients with persistent thrombotic occlusion, not only in life- or limb-threatening VTE. Methods We evaluated 12 consecutive patients (11–17 years) with newly diagnosed VTE being treated at our department during the last 4 years (2017–2020). In case follow-up examination showed persistent venoocclusion under anticoagulation, patients received secondary interventional therapy like recanalization, percutaneous transluminal angioplasty with or without catheter-directed thrombolysis, and stenting. Patients with no clinical signs of venoocclusion or regredient thrombosis in imaging examination received anticoagulation alone. Results Six of 12 (50%) patients underwent catheter intervention. Median time from diagnosis to intervention was 4 months (0–12 months). Reintervention was necessary in one (8%) case and complete recanalization failed in one (8%) case. There were no major bleeding events or other major postinterventional complications, no acute or late local recurrence, and all patients reported clinical improvement after the procedure. Conclusion If endovascular intervention is used in teenage patients with persistent symptomatic VTE, reduction of postthrombotic symptoms is possible, even if intervention is performed secondary to failure of anticoagulation. Multidisciplinary treatment decisions can be based on the clinical course and follow-up imaging.

Current Diagnostic and Therapeutic Approaches in May–Thurner Syndrome in Children, Adolescents, and Young Adults: A Survey among Thrombosis Experts of the German Society of Thrombosis and Haemostasis

“…The safety and efficacy of secondary endovascular intervention in pediatric patients with iliac and/or femoral thrombosis after up to 12 months after diagnosis have been recently demonstrated in a study that involved 12 pediatric patients. 14 Another important question is how effectiveness and safety of any therapeutic approach are best evaluated. Many studies use PTS as outcome parameter after thrombosis.…”

“…The safety and efficacy of secondary endovascular intervention in pediatric patients with iliac and/or femoral thrombosis after up to 12 months after diagnosis have been recently demonstrated in a study that involved 12 pediatric patients. 14…”

“…6 A recent study on 12 pediatric patients with thrombosis reported low rates of PTS both after endovascular treatment and anticoagulation alone with secondary endovascular intervention being safe and efficient in case of persistent signs of veno-occlusion despite therapeutic anticoagulation. 14…”

“…6 A recent study on 12 pediatric patients with thrombosis reported low rates of PTS both after endovascular treatment and anticoagulation alone with secondary endovascular intervention being safe and efficient in case of persistent signs of veno-occlusion despite therapeutic anticoagulation. 14 The potential advantages of image-guided endovascular treatment methods must be weighed against the risks. Stent implantation seems to improve vessel patency; however, it bears the risk of stent migration, stent thrombosis, and excessive/periprocedural bleeding, although in the few published studies in children and adolescents, bleeding rates were low.…”