Gaballah Marian, Shi Junzi, Kukreja Kamlesh, Raffini Leslie, Tarango Cristina, Keller Marc, Krishnamurthy Ganesh, Racadio John, Patel Manish, Cahill Anne Marie
Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
J Vasc Interv Radiol. 2016 Apr;27(4):524-30. doi: 10.1016/j.jvir.2015.12.753. Epub 2016 Mar 2.
To evaluate technical feasibility, complications, and clinical outcomes of endovascular thrombolysis for iliofemoral thrombosis at two tertiary-care children's hospitals.
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).
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.
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.
评估两家三级儿童专科医院对髂股静脉血栓形成进行血管内溶栓治疗的技术可行性、并发症及临床疗效。
经机构审查委员会批准，对2003年3月至2013年6月期间的病例进行回顾性研究，结果显示，57例（64条肢体）髂股静脉血栓形成患儿接受了静脉溶栓治疗，中位年龄为16.1岁（平均年龄14.5岁；范围1.0 - 17.8岁）。治疗技术包括导管直接溶栓（CDT）、经皮机械血栓清除术（PMT）以及联合血管成形术和/或支架置入的药物机械导管直接溶栓（PCDT）。对随访数据进行回顾性应用Villalta量表和改良Villalta量表，以评估血栓形成后综合征（PTS）。
技术成功率（溶栓率≥50%）为93.7%：19条肢体为III级（100%），41条肢体为II级（50% - 99%），4条肢体为I级（<50%）。治疗技术包括CDT联合PCDT（32.8%）或PMT（35.9%）、单纯CDT（26.6%）、单纯PCDT（4.7%）或联合血管成形术（54.7%）以及支架置入（6.3%）。CDT的平均持续时间为36.5小时（范围2.9 - 89.6小时）。发生1例严重并发症（1.8%），为需要输血的出血。7例患者（12.2%）出现轻微并发症（即出血）。中位随访时间为1.5年（范围30天至7年）。7例患者因复发性血栓形成接受了重复溶栓治疗。根据改良Villalta量表，PTS发生率为59.3%，但根据Villalta量表仅为2.1%。
血管内溶栓治疗儿童髂股静脉血栓形成在技术上是可行且安全的。两种评估PTS的量表结果存在差异，提示迫切需要对儿童结局测量进行标准化。
