Texas Tech University Health Science Center School of Medicine, Lubbock, TX, USA.
Division of Interventional Radiology, Department of Radiology, Texas Children's Hospital, Houston, TX, USA.
Pediatr Radiol. 2024 Aug;54(9):1540-1548. doi: 10.1007/s00247-024-05985-7. Epub 2024 Jul 11.
Pediatric iliofemoral venous thromboembolism that is resistant to conventional treatments poses significant management challenges. Stent placement represents a potentially underutilized strategy in children when stenosis or thrombosis persists intraprocedurally or recurs postoperatively, despite treatments such as venoplasty, lysis, and thrombectomy.
This study aims to report our institutional experience with iliofemoral stenting in 17 pediatric patients with recurrent iliofemoral venous thromboembolism or stenosis.
We performed an IRB-approved retrospective review of pediatric patients (<18 years of age) who underwent iliofemoral venous stenting for recurrent stenosis or thrombosis between January 2012 and December 2022 at a single tertiary care institution. Patient demographics, risk factors for venous thromboembolism, presenting symptoms, and procedural characteristics were recorded. The primary outcome was stent patency rates at interval imaging follow-up.
Seventeen patients with mean age of 14.6 years (range 7-17) and mean BMI of 27.7 were stented during the study period. Sixteen of 17 patients presented with evidence of May-Thurner anatomy. 14/17 patients presented with acute iliofemoral venous thromboembolism, 2/17 with chronic venous thromboembolism, and 1/17 with left lower extremity swelling without thrombosis. Seventy-three total angiographic procedures were performed, which included angioplasty, lysis, and thrombectomy, and 23 stent placements. Patients underwent an average of 3 procedures (range 1-9) over a mean of 2.8 months (range 0-17 months) prior to undergoing stent placement. Stents were deployed successfully in all patients. The median follow-up was 18 months (range, 1-77 months). Primary and secondary patency rates were 13/17 (76%) and 14/14 (100%) at 12 months and 12/17 (71%) and 14/14 (100%) at 24 months, respectively.
In our experience of 17 patients, stent placement appears to be a durable option for children with iliofemoral venous thromboembolism following failure to establish vessel patency or development of recurrent thrombosis/stenosis postoperatively.
对于常规治疗无效的小儿髂股静脉血栓栓塞症，治疗管理极具挑战性。对于术中仍存在狭窄或血栓形成，或尽管已进行血管成形术、溶栓和血栓切除术等治疗但术后仍复发的患者，支架置入术是一种潜在的未充分利用的策略。
本研究旨在报告我们机构对 17 例复发性髂股静脉血栓栓塞或狭窄的儿科患者进行髂股静脉支架置入的经验。
我们对 2012 年 1 月至 2022 年 12 月在一家三级医疗中心接受髂股静脉支架置入术以治疗复发性狭窄或血栓形成的<18 岁的儿科患者进行了经机构审查委员会批准的回顾性研究。记录患者的人口统计学数据、静脉血栓栓塞的危险因素、临床表现和手术特点。主要结局是在间隔影像学随访时的支架通畅率。
在研究期间，17 例平均年龄 14.6 岁（范围 7-17 岁）、平均 BMI 为 27.7 的患者接受了支架置入术。17 例患者中有 16 例存在麦氏解剖异常。14/17 例患者表现为急性髂股静脉血栓栓塞，2/17 例为慢性静脉血栓栓塞，1/17 例为左下肢肿胀但无血栓形成。共进行了 73 次血管造影术，包括血管成形术、溶栓和血栓切除术，以及 23 次支架置入术。患者在接受支架置入术之前平均接受了 3 次治疗（范围 1-9 次），平均时间为 2.8 个月（范围 0-17 个月）。所有患者均成功植入支架。中位随访时间为 18 个月（范围 1-77 个月）。12 个月时，主要和次要通畅率分别为 13/17（76%）和 14/14（100%），24 个月时分别为 12/17（71%）和 14/14（100%）。
在我们 17 例患者的经验中，对于术中仍存在狭窄或血栓形成，或术后复发血栓形成/狭窄的患者，支架置入术似乎是一种持久的选择。
