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Endovascular thrombolysis to salvage central venous access in children with catheter-associated upper extremity deep vein thrombosis: technique and initial results

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Abstract

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.

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Conflicts of interest

All authors declare that they have no conflicts of interest.

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Authors and Affiliations

  1. 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

    Matthew P. Lungren & Thomas J. Ward

  2. Division of Pediatric Interventional Radiology, Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Manish N. Patel & John M. Racadio

  3. Division of Pediatric Interventional Radiology, Department of Radiology, Texas Children’s Hospital Medical Center, Houston, TX, USA

    Kamlesh Kukreja

Authors
  1. Matthew P. Lungren
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  2. Thomas J. Ward
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  3. Manish N. Patel
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  4. John M. Racadio
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  5. Kamlesh Kukreja
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Correspondence to Matthew P. Lungren.

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Lungren, M.P., Ward, T.J., Patel, M.N. et al. Endovascular thrombolysis to salvage central venous access in children with catheter-associated upper extremity deep vein thrombosis: technique and initial results. J Thromb Thrombolysis 40, 274–279 (2015). https://doi.org/10.1007/s11239-015-1209-3

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  • DOI: https://doi.org/10.1007/s11239-015-1209-3

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