Hanser Anja, Sieverding Ludger, Hauser Till-Karsten, Wiegand Gesa, Hofbeck Michael
Department of Pediatric Cardiology, University Hospital Tuebingen, Tuebingen, Germany.
Department of Neuroradiology, University Hospital Tuebingen, Tuebingen, Germany.
Catheter Cardiovasc Interv. 2019 May 1;93(6):E357-E361. doi: 10.1002/ccd.28142. Epub 2019 Feb 9.
To describe the efficacy and safety of stent-retriever thrombectomy in infants with thrombosis of the superior vena cava (SVC) and innominate vein.
Thrombosis of the SVC and of the innominate vein is a potentially life threatening complication in infants during intensive care treatment following major surgical procedures. To avoid reoperations, we evaluated interventional revascularization by stent-retriever thrombectomy.
From 2015 to 2017, five infants were diagnosed with acute thrombosis of the SVC and innominate vein following major cardiac or pediatric surgery. Using a femoral venous access and 4 or 5 French guiding catheters stent-retriever systems (4/20 mm or 6/30 mm) were placed into the thrombus and retrieved under suction. We aimed to revascularize not only the SVC but also the innominate, jugular, and subclavian veins.
Following repeated stent retrieving manoeuvers, we were able to reestablish flow in the major veins of all patients. Due to significant residual thrombotic material, we decided to perform additional balloon dilatation of the SVC and innominate vein in 3/5 patients. There were no complications related to the procedure and none of our patients required blood transfusion. Following the intervention, the patients received treatment with low-molecular-weight heparin. Interventional treatment achieved persistent patency of the SVC and innominate vein in all patients.
Stent-retriever thrombectomy is a safe and effective method for interventional treatment of acute thrombosis of the central veins in infants. Due to the large amount of thrombotic material, it is frequently required to combine this method with balloon compression of residual thrombotic material.
描述支架取栓术治疗婴儿上腔静脉（SVC）和无名静脉血栓形成的疗效和安全性。
SVC和无名静脉血栓形成是婴儿在大手术后重症监护治疗期间潜在的危及生命的并发症。为避免再次手术，我们评估了通过支架取栓术进行的介入性血管再通。
2015年至2017年，5例婴儿在心脏或小儿大手术后被诊断为SVC和无名静脉急性血栓形成。通过股静脉入路，使用4或5法国引导导管将支架取栓系统（4/20毫米或6/30毫米）置入血栓并在抽吸下取出。我们的目标不仅是使SVC再通，还要使无名静脉、颈静脉和锁骨下静脉再通。
经过反复的支架取出操作，我们能够使所有患者的主要静脉恢复血流。由于存在大量残留血栓物质，我们决定对3/5的患者对SVC和无名静脉进行额外的球囊扩张。没有与该操作相关的并发症，我们的患者均无需输血。干预后，患者接受低分子量肝素治疗。介入治疗使所有患者的SVC和无名静脉保持通畅。
支架取栓术是治疗婴儿中心静脉急性血栓形成的一种安全有效的介入方法。由于血栓物质量大，经常需要将该方法与对残留血栓物质的球囊压迫相结合。
