Abstract No. 624 Venous thrombolysis and recanalization in pediatric patients: a single-center experience

Venous thrombosis in a pediatric population can be multifactorial such as secondary to extrinsic compression syndromes: Paget-Schroetter syndrome, May-Thurner syndrome (iliac vein thrombosis), hypercoagulable state, PICC or other central venous catheters and can also occur in patients with arteriovenous fistulae or grafts in patients requiring long-term hemodialysis. DVT affects 0.07-0.14 in 10,000 children annually;58 per 10,000 in hospitalized children. Catheter-directed thrombolysis (CDT), venous angioplasty, stent placement, and mechanical thrombectomy are used to treat both acute and chronic venous thrombosis. However, there is paucity of literature-based evidence on specific indications, efficacy, and safety of this treatment in a large cohort of pediatric patients resulting in inconsistent referral pattern and underutilization of this modality. We present data from a single pediatric center on venous recanalization to elucidate 1. Results of CDT 2. Effect of variables such as clot chronicity, age, disease etiology, administration of anticoagulation on the overall outcome 3. Determine if it is possible to outline specific guidelines for management pertinent to specific group of diseases. Electronic records at a single institution were searched for catheter-directed thrombolysis, thrombectomy, venous angioplasty, and stent placement. Between 2012 and 2019, 118 procedures of CDT were performed in 106 patients (56 females) Various etiologies of venous thrombosis were identified. Medical records for the patient cohort was reviewed and analyzed for relevant clinical information (symptoms at presentation, medications including anti-coagulation, underlying hypercoagulable disorder). Outcomes related to the technical success of procedure (restoration of vessel patency) and clinical success (resolution of symptoms) were evaluated by multivariate analysis. Patency rates (primary, primary-assisted, secondary), signs and symptoms of postthrombotic syndrome and complications were documented and will be discussed. Catheter-directed thrombolysis is an effective treatment modality in chronic multifactorial venous thrombosis in pediatric patients.