Endovascular Thrombosis Treatment

  • Michael Temple
  • Anne Marie Cahill
  • Leonardo R. Brandão


The treatment of pediatric thrombosis is in evolution. In previous decades, anticoagulation and surgical thrombectomy were the only treatments available. Recently multiple generations of thrombolytic drugs and a number of endovascular thrombus removal techniques have been developed to improve patient outcomes. This chapter provides an overview of pediatric thrombosis and discusses current endovascular treatment methods.


International Normalize Ratio Kawasaki Disease Deep Venous Thrombosis Tissue Plasminogen Activator Arterial Thrombosis 


  1. 1.
    Andrew M, David M, Adams M, Ali K, Anderson R, Barnard D, et al. Venous thromboembolic complications (VTE) in children: first analyses of the Canadian Registry of VTE. Blood. 1994;83(5):1251–7. PubMed PMID: 8118029. Epub 1994/03/01.eng.PubMedGoogle Scholar
  2. 2.
    Raffini L, Huang YS, Witmer C, Feudtner C. Dramatic increase in venous thromboembolism in children’s hospitals in the United States from 2001 to 2007. Pediatrics. 2009;124(4):1001–8. PubMed PMID: 19736261. Epub 2009/09/09.eng.PubMedCrossRefGoogle Scholar
  3. 3.
    Wang M, Hays T, Balasa V, Bagatell R, Gruppo R, Grabowski EF, et al. Low-dose tissue plasminogen activator thrombolysis in children. J Pediatr Hematol Oncol. 2003;25(5):379–86. PubMed PMID: 12759624. Epub 2003/05/22.eng.PubMedCrossRefGoogle Scholar
  4. 4.
    Monagle P, Adams M, Mahoney M, Ali K, Barnard D, Bernstein M, et al. Outcome of pediatric thromboembolic disease: a report from the Canadian Childhood Thrombophilia Registry. Pediatr Res. 2000;47(6):763–6. PubMed PMID: 10832734. Epub 2000/06/01.eng.PubMedCrossRefGoogle Scholar
  5. 5.
    Albisetti M. Thrombolytic therapy in children. Thromb Res. 2006;118(1):95–105. PubMed PMID: 16709478. Epub 2006/05/20.eng.PubMedCrossRefGoogle Scholar
  6. 6.
    Gupta AA, Leaker M, Andrew M, Massicotte P, Liu L, Benson LN, et al. Safety and outcomes of thrombolysis with tissue plasminogen activator for treatment of intravascular thrombosis in children. J Pediatr. 2001;139(5):682–8. PubMed PMID: 11713447. Epub 2001/11/20.eng.PubMedCrossRefGoogle Scholar
  7. 7.
    Goldenberg NA. Long-term outcomes of venous thrombosis in children. Curr Opin Hematol. 2005; 12(5):370–6. PubMed PMID: 16093782. Epub 2005/08/12.eng.PubMedCrossRefGoogle Scholar
  8. 8.
    Hausler M, Hubner D, Delhaas T, Muhler EG. Long term complications of inferior vena cava thrombosis. Arch Dis Child. 2001;85(3):228–33. PubMed PMID: 11517106. Pubmed Central PMCID: 1718896. Epub 2001/08/23.eng.PubMedCentralPubMedCrossRefGoogle Scholar
  9. 9.
    Goldenberg NA, Donadini MP, Kahn SR, Crowther M, Kenet G, Nowak-Gottl U, et al. Post-thrombotic syndrome in children: a systematic review of frequency of occurrence, validity of outcome measures, and prognostic factors. Haematologica. 2010; 95(11):1952–9. PubMed PMID: 20595095. Pubmed Central PMCID: 2966919. Epub 2010/07/03.eng.PubMedCentralPubMedCrossRefGoogle Scholar
  10. 10.
    Taylor LM Jr, Troutman R, Feliciano P, Menashe V, Sunderland C, Porter JM. Late complications after femoral artery catheterization in children less than five years of age. J Vasc Surg. 1990;11(2):297–304; discussion 304–6. PubMed PMID: 2405199. Epub 1990/02/01.eng.Google Scholar
  11. 11.
    Goldenberg NA, Durham JD, Knapp-Clevenger R, Manco-Johnson MJ. A thrombolytic regimen for high-risk deep venous thrombosis may substantially reduce the risk of postthrombotic syndrome in children. Blood. 2007;110(1):45–53. PubMed PMID: 17360940. Pubmed Central PMCID: 1896126. Epub 2007/03/16.eng.PubMedCentralPubMedCrossRefGoogle Scholar
  12. 12.
    Goldenberg NA, Knapp-Clevenger R, Manco-Johnson MJ. Elevated plasma factor VIII and D-dimer levels as predictors of poor outcomes of thrombosis in children. N Engl J Med. 2004;351(11):1081–8.PubMedCrossRefGoogle Scholar
  13. 13.
    Kim HS, Patra A, Paxton BE, Khan J, Streiff MB. Adjunctive percutaneous mechanical thrombectomy for lower-extremity deep vein thrombosis: clinical and economic outcomes. J Vasc Interv Radiol. 2006; 17(7):1099–104.PubMedCrossRefGoogle Scholar
  14. 14.
    Lin PH, Zhou W, Dardik A, Mussa F, Kougias P, Hedayati N, et al. Catheter-direct thrombolysis versus pharmacomechanical thrombectomy for treatment of symptomatic lower extremity deep venous thrombosis. Am J Surg. 2006;192:782–8.PubMedCrossRefGoogle Scholar
  15. 15.
    Karthikesalingam A, Young EL, Hinchliffe RJ, Loftus IM, Thompson MM, Holt PJ. A systematic review of percutaneous mechanical thrombectomy in the treatment of deep venous thrombosis. Eur J Vasc Endovasc Surg. 2011;41:554–65.PubMedCrossRefGoogle Scholar
  16. 16.
    Parmar N, Albisetti M, Berry LR, Chan AK. The fibrinolytic system in newborns and children. Clin Lab. 2006;52(3–4):115–24. PubMed PMID: 16584057. Epub 2006/04/06.eng.PubMedGoogle Scholar
  17. 17.
    Andrew M, Paes B, Milner R, Johnston M, Mitchell L, Tollefsen DM, et al. Development of the human coagulation system in the full-term infant. Blood. 1987;70(1):165–72. PubMed PMID: 3593964. Epub 1987/07/01.eng.PubMedGoogle Scholar
  18. 18.
    Ries M. Molecular and functional properties of fetal plasminogen and its possible influence on clot lysis in the neonatal period. Semin Thromb Hemost. 1997;23(3):247–52. PubMed PMID: 9255905. Epub 1997/01/01.eng.PubMedCrossRefGoogle Scholar
  19. 19.
    Andrew M, Brooker L, Leaker M, Paes B, Weitz J. Fibrin clot lysis by thrombolytic agents is impaired in newborns due to a low plasminogen concentration. Thromb Hemost. 1992;68(3):325–30. PubMed PMID: 1440499. Epub 1992/09/07.eng.Google Scholar
  20. 20.
    Grabowski EF. Thrombolysis, flow, and vessel wall interactions. J Vasc Interv Radiol. 1995;6(6 Pt 2 Suppl):25S–9. PubMed PMID: 8770839. Epub 1995/11/01.eng.PubMedCrossRefGoogle Scholar
  21. 21.
    Mewissen MW, Seabrook GR, Meissner MH, Cynamon J, Labropoulos N, Haughton SH. Catheter-directed thrombolysis for lower extremity deep venous thrombosis: report of a national multicenter registry. Radiology. 1999;211(1):39–49. PubMed PMID: 10189452. Epub 1999/04/06.eng.PubMedCrossRefGoogle Scholar
  22. 22.
    O’Sullivan GJ. The role of interventional radiology in the management of deep venous thrombosis: advanced therapy. Cardiovasc Intervent Radiol. 2011;34(3):445–61. PubMed PMID: 20927522. Epub 2010/10/12.eng.PubMedCrossRefGoogle Scholar
  23. 23.
    Monagle P, Chan AK, Goldenberg NA, Ichord RN, Journeycake JM, Nowak-Gottl U, et al. Antithrombotic therapy in neonates and children: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2 Suppl):e737S–801. PubMed PMID: 22315277. Pubmed Central PMCID: 3278066. Epub 2012/02/15.eng.PubMedCentralPubMedGoogle Scholar
  24. 24.
    Patel NH, Krishnamurthy VN, Kim S, Saad WE, Ganguli S, Walker TG, et al. Quality improvement guidelines for percutaneous management of acute lower-extremity ischemia. J Vasc Interv Radiol. 2013;24(1):3–15. PubMed PMID: 23273693. Epub 2013/01/01.eng.PubMedCrossRefGoogle Scholar
  25. 25.
    Vedantham S, Thorpe PE, Cardella JF, Grassi CJ, Patel NH, Ferral H, et al. Quality improvement guidelines for the treatment of lower extremity deep vein thrombosis with use of endovascular thrombus removal. J Vasc Interv Radiol. 2009;20:S227–39.PubMedCrossRefGoogle Scholar
  26. 26.
    Kenet G, Nowak-Gottl U. Hemostasis and thrombosis in pediatric patients: special issues and unique concerns. Semin Thromb Hemost. 2011;37(7):721–2. PubMed PMID: 22187393. Epub 2011/12/22.eng.PubMedCrossRefGoogle Scholar
  27. 27.
    Young G, Albisetti M, Bonduel M, Brandao L, Chan A, Friedrichs F, et al. Impact of inherited thrombophilia on venous thromboembolism in children: a systematic review and meta-analysis of observational studies. Circulation. 2008;118(13):1373–82. PubMed PMID: 18779442. Epub 2008/09/10.eng.PubMedCrossRefGoogle Scholar
  28. 28.
    Raffini L. Thrombophilia in children: who to test, how, when, and why? Hematology Am Soc Hematol Educ Program. 2008:228–35. doi:  10.1182/asheducation-2008.1.228. PubMed PMID: 19074088. Epub 2008/12/17.Eng.
  29. 29.
    Price VE, Chan AK. Arterial thrombosis in children. Expert Rev Cardiovasc Ther. 2008;6(3):419–28. PubMed PMID: 18328000. Epub 2008/03/11.eng.PubMedCrossRefGoogle Scholar
  30. 30.
    Semba CP, Murphy TP, Bakal CW, Calis KA, Matalon TA. Thrombolytic therapy with use of alteplase (rt-PA) in peripheral arterial occlusive disease: review of the clinical literature. The Advisory Panel. J Vasc Interv Radiol. 2000;11(2 Pt 1):149–61. PubMed PMID: 10716384. Epub 2000/03/15.eng.PubMedCrossRefGoogle Scholar
  31. 31.
    Israels SJ, Michelson AD. Antiplatelet therapy in children. Thromb Res. 2006;118(1):75–83. PubMed PMID: 16709476. Epub 2006/05/20.eng.PubMedCrossRefGoogle Scholar
  32. 32.
    Hofmann LV, Razavi M, Arepally A, Reginelli JP, Resar J, Geschwind JF, et al. GPIIb-IIIa receptor inhibitors: what the interventional radiologist needs to know. Cardiovasc Intervent Radiol. 2001;24(6):361–7. PubMed PMID: 11907740. Epub 2002/03/22.eng.PubMedCrossRefGoogle Scholar
  33. 33.
    Chang R, Horne III MK, Shawker TH, Kam AW, Chen EA, Joe GO, et al. Low-dose, once-daily, intraclot injections of alteplase for treatment of acute deep venous thrombosis. J Vasc Interv Radiol. 2011; 22:1107–16.PubMedCentralPubMedCrossRefGoogle Scholar
  34. 34.
    Grunwald MR, Hofmann LV. Comparison of urokinase, alteplase, and reteplase for catheter-directed thrombolysis of deep venous thrombosis. J Vasc Interv Radiol. 2004;15(4):347–52. PubMed PMID: 15064337. Epub 2004/04/06.eng.PubMedCrossRefGoogle Scholar
  35. 35.
    Bookstein JJ, Bookstein FL. Augmented experimental pulse-spray thrombolysis with tissue plasminogen activator, enabling dose reduction by one or more orders of magnitude. J Vasc Interv Radiol. 2000; 11(3):299–303. PubMed PMID: 10735423. Epub 2000/03/29.eng.PubMedCrossRefGoogle Scholar
  36. 36.
    Semba CP, Weck S, Patapoff T. Alteplase: stability and bioactivity after dilution in normal saline solution. J Vasc Interv Radiol. 2003;14(1):99–102. PubMed PMID: 12525593. Epub 2003/01/15.eng.PubMedCrossRefGoogle Scholar
  37. 37.
    Yee DL, Chan AK, Williams S, Goldenberg NA, Massicotte MP, Raffini LJ. Varied opinions on thrombolysis for venous thromboembolism in infants and children: findings from a survey of pediatric hematology-oncology specialists. Pediatr Blood Cancer. 2009;53(6):960–6. PubMed PMID: 19544387. Epub 2009/06/23.eng.PubMedCrossRefGoogle Scholar
  38. 38.
    Leary SE, Harrod VL, de Alarcon PA, Reiss UM. Low-dose systemic thrombolytic therapy for deep vein thrombosis in pediatric patients. J Pediatr Hematol Oncol. 2010;32(2):97–102. PubMed PMID: 20118811. Epub 2010/02/02.eng.PubMedCentralPubMedCrossRefGoogle Scholar
  39. 39.
    Giacoia GP. High-dose urokinase therapy in newborn infants with major vessel thrombosis. Clin Pediatr (Phila). 1993;32(4):231–7. PubMed PMID: 8462236. Epub 1993/04/01.eng.CrossRefGoogle Scholar
  40. 40.
    Robinson A, Fellows KE, Bridges ND, Rome JJ. Effectiveness of pharmacomechanical thrombolysis in infants and children. Am J Cardiol. 2001;87:496–9, A8.Google Scholar
  41. 41.
    Strife JL, Ball Jr WS, Towbin R, Keller MS, Dillon T. Arterial occlusions in neonates: use of fibrinolytic therapy. Radiology. 1988;166(2):395–400. PubMed PMID: 3336714. Epub 1988/02/01.eng.PubMedGoogle Scholar
  42. 42.
    Manco-Johnson MJ. How I, treat venous thrombosis in children. Blood. 2006;107(1):21–9. PubMed PMID: 16099882. Pubmed Central PMCID: 1895344. Epub 2005/08/16.eng.PubMedCentralPubMedCrossRefGoogle Scholar
  43. 43.
    Bassareo PP, Fanos V, Iacovidou N, Mercuro G. Antiplatelet therapy in children: why so different from adults? Curr Pharm Des. 2012;18(21):3019–33. PubMed PMID: 22385057. Epub 2012/03/06.Eng.PubMedCrossRefGoogle Scholar
  44. 44.
    Parikh S, Motarjeme A, McNamara T, Raabe R, Hagspiel K, Benenati JF, et al. Ultrasound-accelerated thrombolysis for the treatment of deep vein thrombosis: initial clinical experience. J Vasc Interv Radiol. 2008;19(4):521–8. PubMed PMID: 18375296. Epub 2008/04/01.eng.PubMedCrossRefGoogle Scholar
  45. 45.
    Lee KH, Han H, Lee KJ, Yoon CS, Kim SH, Won JY, et al. Mechanical thrombectomy of acute iliofemoral deep vein thrombosis with use of an Arrow-Trerotola percutaneous thrombectomy device. J Vasc Interv Radiol. 2006;17(3):487–95. PubMed PMID: 16567673.Epub 2006/03/29.eng.PubMedCrossRefGoogle Scholar
  46. 46.
    Atherton ME, Culp WC, Brown AT, Erdem E. Successful intravascular ultrasound thrombolysis of dural sinus thrombosis with pre-existing subarachnoid and intraparenchymal hemorrhages. Interv Neuroradiol. 2010;16:455–8.PubMedCentralPubMedGoogle Scholar
  47. 47.
    Maxwell AD, Owens G, Gurm HS, Ives K, Myers Jr DD, Xu Z. Noninvasive treatment of deep venous thrombosis using pulsed ultrasound cavitation therapy (histotripsy) in a porcine model. J Vasc Interv Radiol. 2011;22(3):369–77.PubMedCentralPubMedCrossRefGoogle Scholar
  48. 48.
    Siegel RJ, Luo H. Ultrasound thrombolysis. Ultrasonics. 2008;48:312–20.PubMedCrossRefGoogle Scholar
  49. 49.
    O’Sullivan GJ, Semba CP, Bittner CA, Kee ST, Razavi MK, Sze DY, et al. Endovascular management of iliac vein compression (May-Thurner) syndrome. J Vasc Interv Radiol. 2000;11(7):823–36. PubMed PMID: 10928517. Epub 2000/08/06.eng.PubMedCrossRefGoogle Scholar
  50. 50.
    Razavi MK, Hansch EC, Kee ST, Sze DY, Semba CP, Dake MD. Chronically occluded inferior venae cavae: endovascular treatment. Radiology. 2000;214(1):133–8. PubMed PMID: 10644112. Epub 2000/01/22.eng.PubMedCrossRefGoogle Scholar
  51. 51.
    Guimaraes M, Schonholz C, Hannegan C, Anderson MB, Shi J, Selby Jr B. Radiofrequency wire for the recanalization of central vein occlusions that have failed conventional endovascular techniques. J Vasc Interv Radiol. 2012;23(8):1016–21. PubMed PMID: 22739648. Epub 2012/06/29.eng.PubMedCrossRefGoogle Scholar
  52. 52.
    Iafrati M, Maloney S, Halin N. Radiofrequency thermal wire is a useful adjunct to treat chronic central venous occlusions. J Vasc Surg. 2012;55(2):603–6. PubMed PMID: 22104339.Epub 2011/11/23.eng.PubMedCrossRefGoogle Scholar
  53. 53.
    Sharifi M, Bay C, Skrocki L, Lawson D, Mazdeh S. Role of IVC filters in endovenous therapy for deep venous thrombosis: the FILTER-PEVI (Filter Implantation to Lower Thromboembolic Risk in Percutaneous Endovenous Intervention) Trial. Cardiovasc Intervent Radiol. 2012;35(6):1408–13. PubMed PMID: 22271078. Epub 2012/01/25.eng.PubMedCrossRefGoogle Scholar
  54. 54.
    Chaudry G, Padua HM, Alomari AI. The use of inferior vena cava filters in young children. J Vasc Interv Radiol. 2008;19:1103–6.PubMedCrossRefGoogle Scholar
  55. 55.
    Kandarpa K. Technical determinants of success in catheter-directed thrombolysis for peripheral arterial occlusions. J Vasc Interv Radiol. 1995;6(6 Pt 2 Suppl):55S–61. PubMed PMID: 8770843. Epub 1995/11/01.eng.PubMedCrossRefGoogle Scholar
  56. 56.
    Dwarka D, Schwartz SA, Smyth SH, O’Brien MJ. Bradyarrhythmias during use of the AngioJet system. J Vasc Interv Radiol. 2006;17(10):1693–5. PubMed PMID: 17057013.Epub 2006/10/24.eng.PubMedCrossRefGoogle Scholar
  57. 57.
    Kuo WT, Gould MK, Louie JD, Rosenberg JK, Sze DY, Hofmann LV. Catheter-directed therapy for the treatment of massive pulmonary embolism: systematic review and meta-analysis of modern techniques. J Vasc Interv Radiol. 2009;20(11):1431–40. PubMed PMID: 19875060. Epub 2009/10/31.eng.PubMedCrossRefGoogle Scholar
  58. 58.
    Jaff MR, McMurtry MS, Archer SL, Cushman M, Goldenberg N, Goldhaber SZ, et al. Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: a scientific statement from the American Heart Association. Circulation. 2011;123(16):1788–830. PubMed PMID: 21422387. Epub 2011/03/23.eng.PubMedCrossRefGoogle Scholar
  59. 59.
    Goldenberg NA, Branchford B, Wang M, Ray Jr C, Durham JD, Manco-Johnson MJ. Percutaneous mechanical and pharmacomechanical thrombolysis for occlusive deep vein thrombosis of the proximal limb in adolescent subjects: findings from an institution-based prospective inception cohort study of pediatric venous thromboembolism. J Vasc Interv Radiol. 2011;22(2):121–32. PubMed PMID: 21216157. Pubmed Central PMCID: 3058325. Epub 2011/01/11.eng.PubMedCentralPubMedCrossRefGoogle Scholar
  60. 60.
    Monagle P, Chalmers E, Chan A, DeVeber G, Kirkham F, Massicotte P, et al. Antithrombotic therapy in neonates and children: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest. 2008;133(6 Suppl): 887S–968. PubMed PMID: 18574281.Epub 2008/07/24.eng.PubMedCrossRefGoogle Scholar
  61. 61.
    O’Sullivan GJ, Lohan DG, Gough N, Cronin CG, Kee ST. Pharmacomechanical thrombectomy of acute deep vein thrombosis with the Trellis-8 isolated thrombolysis catheter. J Vasc Interv Radiol. 2007;18(6):715–24. PubMed PMID: 17538133. Epub 2007/06/01.eng.PubMedCrossRefGoogle Scholar
  62. 62.
    Thompson JF, Winterborn RJ, Bays S, White H, Kinsella DC, Watkinson AF. Venous thoracic outlet compression and the Paget-Schroetter syndrome: a review and recommendations for management. Cardiovasc Intervent Radiol. 2011;34(5):903–10. PubMed PMID: 21448772. Epub 2011/03/31.eng.PubMedCrossRefGoogle Scholar
  63. 63.
    Raffini L, Raybagkar D, Cahill AM, Kaye R, Blumenstein M, Manno C. May-Thurner syndrome (iliac vein compression) and thrombosis in adolescents. Pediatr Blood Cancer. 2006;47(6):834–8. PubMed PMID: 16365865. Epub 2005/12/21.eng.PubMedCrossRefGoogle Scholar
  64. 64.
    Molina JE, Hunter DW, Dietz CA. Protocols for Paget-Schroetter syndrome and late treatment of chronic subclavian vein obstruction. Ann Thorac Surg. 2009;87(2):416–22. PubMed PMID: 19161749. Epub 2009/01/24.eng.PubMedCrossRefGoogle Scholar
  65. 65.
    Biss TT, Kahr WH, Brandao LR, Chan AK, Thomas KE, Williams S. The use of elastic compression stockings for post-thrombotic syndrome in a child. Pediatr Blood Cancer. 2009;53(3):462–3. PubMed PMID: 19459199. Epub 2009/05/22.eng.PubMedCrossRefGoogle Scholar
  66. 66.
    Monagle P, Newall F, Barnes C, Savoia H, Campbell J, Wallace T, et al. Arterial thromboembolic disease: a single-centre case series study. J Paediatr Child Health. 2008;44(1–2):28–32. PubMed PMID: 17803664. Epub 2007/09/07.eng.PubMedGoogle Scholar
  67. 67.
    Balci YI, Unal S, Gumruk F, Cetin M, Ozkutlu S, Gurgey A. Nonstroke arterial thrombosis in children: Hacettepe experience. Blood Coagul Fibrinolysis. 2008;19:519–24.PubMedCrossRefGoogle Scholar
  68. 68.
    Coombs CJ, Richardson PW, Dowling GJ, Johnstone BR, Monagle P. Brachial artery thrombosis in infants: an algorithm for limb salvage. Plast Reconstr Surg. 2006;117:1481–8.PubMedCrossRefGoogle Scholar
  69. 69.
    Price V, Massicotte MP. Arterial thromboembolism in the pediatric population. Semin Thromb Hemost. 2003;29(6):557–65. PubMed PMID: 14719172. Epub 2004/01/14.eng.PubMedCrossRefGoogle Scholar
  70. 70.
    Streif W, Monagle P, South M, Leaker M, Andrew M. Spontaneous arterial thrombosis in children. J Pediatr. 1999;134:110–2.PubMedCrossRefGoogle Scholar
  71. 71.
    Ino T, Benson LN, Freedom RM, Barker GA, Aipursky A, Rowe RD. Thrombolytic therapy for femoral artery thrombosis after pediatric cardiac catheterization. Am Heart J. 1988;115:633–9.PubMedCrossRefGoogle Scholar
  72. 72.
    Grover I, Conley L, Alzate G, Lavine J, Van Hoesen K, Khanna A. Hyperbaric oxygen therapy for hepatic artery thrombosis following liver transplantation: current concepts. Pediatr Transplant. 2006;10(2):234–9. PubMed PMID: 16573613. Epub 2006/04/01.eng.PubMedCrossRefGoogle Scholar
  73. 73.
    Baserga MC, Puri A, Sola A. The use of topical nitroglycerin ointment to treat peripheral tissue ischemia secondary to arterial line complications in neonates. J Perinatol. 2002;22(5):416–9. PubMed PMID: 12082481. Epub 2002/06/26.eng.PubMedCrossRefGoogle Scholar
  74. 74.
    Theile RJ, Coombs CJ. Microvascular and thrombolytic revascularization of an arm in a 32-week-gestation neonate: case report and review of the literature. J Reconstr Microsurg. 1996;12(8):539–42. PubMed PMID: 8951122. Epub 1996/11/01.eng.PubMedCrossRefGoogle Scholar
  75. 75.
    Neff KW, Dinter D, Schaible T, Lehmann KJ, Duber C. Intraarterial subclavian artery thrombolysis in a neonate. AJR Am J Roentgenol. 2001;177(2):446–8. PubMed PMID: 11461880. Epub 2001/07/20.eng.PubMedCrossRefGoogle Scholar
  76. 76.
    Temple M, Williams S, John P, Chait P, Connolly B. Percutaneous treatment of pediatric thrombosis. Eur J Radiol. 2005;53:14–21.PubMedCrossRefGoogle Scholar
  77. 77.
    Watkins S, Yunge M, Jones D, Kiely E, Petros AJ. Prolonged use of tissue plasminogen activator for bilateral lower limb arterial occlusion in a neonate. J Pediatr Surg. 2001;36:654–6.PubMedCrossRefGoogle Scholar
  78. 78.
    Rutherford RB, Baker JD, Ernst C, Johnston KW, Porter JM, Ahn S, Jones DN. Recommended standards for reports dealing with lower extremity ischemia: revised version. J Vasc Surg. 1997;26(3):517–38.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Michael Temple
    • 1
  • Anne Marie Cahill
    • 2
  • Leonardo R. Brandão
    • 3
  1. 1.Hospital for Sick ChildrenUniversity of TorontoTorontoCanada
  2. 2.Department of RadiologyChildren’s Hospital of PhiladelphiaPhiladelphiaUSA
  3. 3.Division of Hematology/OncologyThe Hospital for Sick ChildrenTorontoCanada

Personalised recommendations