Lungren Matthew P, Ward Thomas J, Patel Manish N, Racadio John M, Kukreja Kamlesh
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,
J Thromb Thrombolysis. 2015 Oct;40(3):274-9. doi: 10.1007/s11239-015-1209-3.
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.
9例导管相关性上肢深静脉血栓形成（UE-DVT）患者（平均年龄8.3岁，范围20天至17岁；平均体重31 kg，范围2.7 - 79 kg）接受了上肢静脉溶栓治疗，目的是挽救血管通路。所有病例均采用阿替普酶（tPA）导管定向治疗、球囊血管成形术和机械性血栓切除术。TPA的平均总剂量为15 mg（范围1 - 40 mg）。所有患者最终均保留了静脉通路。未使用支架或上腔静脉滤器。有1例临床怀疑有症状的肺栓塞，经全身tPA和肝素治疗，无长期后遗症。平均影像学和临床随访时间分别为351±208天和613±498天。儿童导管相关性上肢深静脉血栓形成的腔内溶栓可能是安全有效的，尤其对于需要长期静脉通路的患者可以考虑采用。
