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Percutaneous treatment of symptomatic deep vein thrombosis in adolescents using large-bore thrombectomy systems

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Abstract

Background

While large-bore mechanical thrombectomy provides effective venous thrombus removal, often with avoidance of thrombolytics, literature surrounding the application of these devices in pediatric patients is sparse.

Objective

To report technical success and outcomes following large-bore thrombectomy systems in adolescent patients with deep venous thrombosis.

Materials and Methods

A retrospective review identified all patients less than 18 years of age undergoing mechanical venous thrombectomy at a single institution between 2018 and 2022. No patients were excluded. Technical success was defined as extraction of thrombus sufficient to restore unimpeded flow in affected segments. Clinical success was defined as resolution of presenting symptoms.

Results

Nine consecutive patients (6 females, 3 males; age range 15–17 years) underwent 10 thrombectomy procedures using ClotTriever (n=6; 60%), FlowTriever (n=2; 20%), or both (n=2; 20%). Chronicity of thrombus was categorized as acute (<2 weeks) in 6 (60%), subacute (2–6 weeks) in 1 (10%), and chronic (>6 weeks) in 3 (30%). Distribution of thrombus was lower extremity and/or inferior vena cava (IVC) in 9 (90%) and unilateral axillo-subclavian in 1 (10%). Technical success was achieved in 9 interventions (90%). Clinical success was achieved in 8 patients (88.9%). No patients received thrombolytics. There were no intraprocedural adverse events (AE). Minor complications (Society of Interventional Radiology mild adverse events) were observed in a delayed fashion following 2 interventions (20%).

Conclusions

This preliminary experience demonstrated high rates of technical and clinical success with large-bore deep venous thrombectomy in adolescent patients across a range of thrombus chronicity and locations.

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Data availability

The data generated during the study are available from the corresponding author on reasonable request.

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Funding

This study was not supported by any funding. This study was conducted with institutional review board approval and complied with the Health Insurance Portability and Accountability Act. Informed consent was waived for retrospective, no patient contact methodology. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Authors and Affiliations

  1. Section of Vascular and Interventional Radiology, Department of Radiology, University of Wisconsin, 600 Highland Avenue, Madison, WI, 53792, USA

    Eric J. Monroe, Michael A. Woods, John Swietlik, Aaron Eifler & Jason W. Pinchot

  2. Section of Vascular and Interventional Radiology, Department of Radiology, University of Washington, 1959 Northeast Pacific Street, Seattle, WA, USA

    David S. Shin, Joseph Reis III & Jeffrey Forris Beecham Chick

Authors
  1. Eric J. Monroe
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  2. Michael A. Woods
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  3. David S. Shin
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  4. Joseph Reis III
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  5. John Swietlik
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  6. Aaron Eifler
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  7. Jason W. Pinchot
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  8. Jeffrey Forris Beecham Chick
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Contributions

E.J.M. and M.A.W. conceived the study, collated and analyzed the data, and drafted the manuscript. All authors contributed to, reviewed, and approved the manuscript.

Corresponding author

Correspondence to Eric J. Monroe.

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Conflicts of interest

E.J.M. is a scientific advisor and speaker for Biogen. J.F.B.C. is a consultant and speaker for Inari Medical, Guerbet, C. R. Bard, Argon Medical Devices, Boston Scientific, and NXT Biomedical. None of the other authors have identified a conflict of interest.

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Monroe, E.J., Woods, M.A., Shin, D.S. et al. Percutaneous treatment of symptomatic deep vein thrombosis in adolescents using large-bore thrombectomy systems. Pediatr Radiol 53, 2692–2698 (2023). https://doi.org/10.1007/s00247-023-05785-5

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  • DOI: https://doi.org/10.1007/s00247-023-05785-5

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