scholarly journals Clinical Outcomes of May–Thurner Syndrome in Pediatric Patients: A Single Institutional Experience

TH Open ◽  
2020 ◽  
Vol 04 (03) ◽  
pp. e189-e196
Author(s):  
Deepti M. Warad ◽  
Amulya Nageswara Rao ◽  
Haraldur Bjarnason ◽  
Vilmarie Rodriguez
Keyword(s):  
Pediatric Patients ◽  
Retrospective Chart Review ◽  
Signs And Symptoms ◽  
Adjunctive Treatment ◽  
Bleeding Complications ◽  
Postthrombotic Syndrome ◽  
Common Iliac Vein ◽  
Endovascular Stents ◽  
Systemic Thrombolysis ◽  
Catheter Directed Thrombolysis

Abstract Introduction May–Thurner syndrome (MTS) is a vascular anatomic variant resulting in compression of the left common iliac vein by the right common iliac artery, affecting approximately 22% of the population. In adults, following acute deep vein thrombosis (DVT) of the iliofemoral veins, the incidence of postthrombotic syndrome (PTS) and recurrent DVT are high if treated with anticoagulation alone, warranting adjunctive treatment with thrombolysis and stent placement. However, there is paucity of literature documenting the course of treatment and associated outcomes in pediatric patients with MTS. Methods A retrospective chart review of pediatric patients (≤ 18 years of age) with radiologic confirmation of MTS with or without DVT evaluated and/or treated at our institution from January 1, 2005 through December 31, 2015 was conducted. Results Seventeen patients (4 male; 13 female) were identified. Median age was 15.4 years (range 8.8–17.1 years) with a median follow-up of 1.2 years (range 0.4–7.5 years). Thirteen (76.5%) patients presented with left lower extremity DVT. Management included catheter-directed thrombolysis (n = 5), systemic thrombolysis (n = 1), and mechanical thrombectomy (n = 1). Fifteen patients were treated with anticoagulation including two patients with endovascular stents without DVT. Median duration of anticoagulation was 6.3 months (range 3.2–18.7 months). Ten patients (59%) underwent stent placements.Complete and partial thrombus resolution was noted in six patients each and no resolution in one patient. Four patients had recurrence/progression of thrombus (n = 3 with stents) at a median time of 29 days (range 12–495 days). No bleeding complications were observed. Clinically documented or self-reported PTS was noted in 8 patients (62%). Conclusion There are no clear guidelines for MTS management in children and adolescents. In our cohort, thrombolysis, anticoagulation, or stent placements were not associated with bleeding risks, with recurrence/progression of DVT and signs and symptoms of PTS noted in 30 and 62%, respectively. Further studies are needed to determine a standardized treatment approach of the pediatric patient with MTS with or without thrombosis.

Bilateral catheter-directed thrombolysis in a patient with deep venous thrombosis caused by a hypoplastic inferior vena cava

2014 ◽  
Vol 30 (4) ◽  
pp. 293-295 ◽  
Author(s):  
S Sloot ◽  
J Van Nierop ◽  
JJ Kootstra ◽  
C Wittens ◽  
WM Fritschy
Keyword(s):  
Inferior Vena Cava ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Inferior Vena ◽  
Vena Cava ◽  
Adolescent Male ◽  
Bleeding Complications ◽  
Systemic Thrombolysis ◽  
Catheter Directed Thrombolysis

Introduction Deep venous thrombosis treatment using catheter-directed thrombolysis is advocated over systemic thrombolysis because it reduces bleeding complications. With the development of a catheter that combines ultrasound vibrations and the local delivering of thrombolytics, new and safer treatments appear that are suitable for more complex problems. Report An adolescent male presented with bilateral iliofemoral thrombosis based on a hypoplastic inferior vena cava that had existed for more than two weeks. He was succesfully treated by bilateral ultrasound-accelerated catheter-directed thrombolysis using EkoSonic® (Small Vessel) Endovascular System (EKOS) and stenting of the inferior vena cava. After eight months of follow-up, the inferior vena cava is still patent. Conclusion EKOS thrombolysis of longer existing bilateral deep venous thrombosis in the central venous system is a succesful treatment modality in congenital inferior vena cava anomalies.

scholarly journals Thrombolytic therapy in acute venous thromboembolism

Hematology ◽  
2020 ◽  
Vol 2020 (1) ◽  
pp. 612-618
Author(s):  
Thita Chiasakul ◽  
Kenneth A. Bauer
Keyword(s):  
Venous Thromboembolism ◽  
Thrombolytic Therapy ◽  
Postthrombotic Syndrome ◽  
Term Survival ◽  
Systemic Thrombolysis ◽  
Thrombolytic Agents ◽  
Catheter Directed Thrombolysis ◽  
Response Team ◽  
Acute Venous Thromboembolism ◽  
Large Clot

Abstract Although anticoagulation remains the mainstay of treatment of acute venous thromboembolism (VTE), the use of thrombolytic agents or thrombectomy is required to immediately restore blood flow to thrombosed vessels. Nevertheless, systemic thrombolysis has not clearly been shown to improve outcomes in patients with large clot burdens in the lung or legs as compared with anticoagulation alone; this is in part due to the occurrence of intracranial hemorrhage in a small percentage of patients to whom therapeutic doses of a thrombolytic drug are administered. Algorithms have been developed to identify patients at high risk for poor outcomes resulting from large clot burdens and at low risk for major bleeding in an effort to improve outcomes in those receiving thrombolytic therapy. In acute pulmonary embolism (PE), hemodynamic instability is the key determinant of short-term survival and should prompt consideration of immediate thrombolysis. In hemodynamically stable PE, systemic thrombolysis is not recommended and should be used as rescue therapy if clinical deterioration occurs. Evidence is accumulating regarding the efficacy of administering reduced doses of thrombolytic agents systemically or via catheters directly into thrombi in an effort to lower bleed rates. In acute deep venous thrombosis, catheter-directed thrombolysis with thrombectomy can be used in severe or limb-threatening thrombosis but has not been shown to prevent postthrombotic syndrome. Because the management of acute VTE can be complex, having a rapid-response team (ie, PE response team) composed of physicians from different specialties may aid in the management of severely affected patients.

scholarly journals Association of risk stratification and mortality outcomes in patients of acute pulmonary embolism

2021 ◽  
Vol 8 (9) ◽  
pp. 1400
Author(s):  
Jit H. Brahmbhatt ◽  
Zeeshan H. Mansuri ◽  
Roopesh R. Singhal
Keyword(s):  
Pulmonary Embolism ◽  
Risk Stratification ◽  
Acute Pulmonary Embolism ◽  
Signs And Symptoms ◽  
High Risk Group ◽  
Intermediate Risk ◽  
Atypical Chest Pain ◽  
Systemic Thrombolysis ◽  
Catheter Directed Thrombolysis ◽  
Acute Pulmonary Thromboembolism

Background: To study the association of risk stratification and mortality outcomes of patients with high/intermediate risk acute pulmonary embolism who are given the guideline directed therapy after the diagnosis of pulmonary embolism.Methods: Prospective observational study of demographics, clinical profile, risk stratification, management and outcome of patients presenting with acute pulmonary embolism from October 2019to December 2020. Risk stratification was done as per ESC 2019 guidelines into high and intermediate categories, intermediate category patients were further stratified into intermediate-high and intermediate-low-risks.Results: 100 patients who were detected to have acute pulmonary thromboembolism with a mean age of 45.08 years with 60% being males were included in the study. There were 31 patients in high-risk group, 59 patients in intermediate-high subgroup, 10 patients in intermediate-low subgroup. Echocardiography was done in all patients. Outcome was relatively grave in these subgroups with overall mortality of 56 patients. 49 patients were thrombolysed with rTPA, 27patients with alteplase, 4 patients with streptokinase, 12patients who had contraindication to systemic thrombolysis were subjected to catheter directed thrombolysis and 8 patients were taken up for surgical embolectomy.Conclusions: Pulmonary embolism can present with unexplained dyspnea and atypical chest pain among other signs and symptoms. Early diagnosis, risk stratification and guideline directed prompt management can lead to favorable outcomes however; patients with high and intermediate risk at presentation are associated with higher mortality rate despite GDT.

Temporal Analysis of Tachycardia During Catheter Directed Thrombolysis for Acute Pulmonary Embolism

2021 ◽  
pp. 153857442110171
Author(s):  
Assaf Graif ◽  
Christopher J. Grilli ◽  
Amanda L. Scott ◽  
Keval D. Patel ◽  
Trelawny J. Zimmermann ◽  
...  
Keyword(s):  
Heart Rate ◽  
Pulmonary Embolism ◽  
Acute Pulmonary Embolism ◽  
Sinus Tachycardia ◽  
Retrospective Chart Review ◽  
Temporal Analysis ◽  
Blocker Therapy ◽  
Systemic Thrombolysis ◽  
Catheter Directed Thrombolysis ◽  
Sustained Reduction

Purpose: To evaluate the effect of catheter directed thrombolysis (CDT) on heart rate (HR) in patients with sinus tachycardia and acute pulmonary embolism (PE). Methods: A retrospective chart review was performed for patients who underwent CDT with tPA for acute massive or submassive PE between 12/2009 and 2/2020. Included were patients who presented with tachycardia at the time of initiation of CDT. Patients with chronic PE, atrial fibrillation, beta blocker therapy, adjunctive endovascular therapy, systemic thrombolysis, or who expired before conclusion of CDT were excluded. HR was measured approximately every hour during CDT. Graphs were plotted of HR as a function of CDT duration. Two interventional radiologists identified the point of plateau (POP) on the graph where CDT had maximized its benefit in decreasing the patient’s HR. Discrepancies were adjudicated by a third interventional radiologist and the median of the 3 measurements was selected. The primary endpoint was the duration of CDT from initiation until the POP. Results: 48 patients were included (52.5 ± 14.7 years, 56.3% female). The POP occurred after 13.1 ± 6.1 hours, by which point HR had been reduced from 110 ± 9.2 bpm to 88 ± 10.6 bpm. Sinus tachycardia was not resolved in 10 patients even though they achieved maximal improvement in HR after 11.3 ± 6.7 hours. Conclusion: Patients presenting with sinus tachycardia related to acute PE achieved maximal, sustained reduction in heart rate from CDT, after approximately 13 hours of infusion. Patients who did not resolve their tachycardia by that point in time were unlikely to resolve it by the conclusion of CDT.

Assessment of Anticoagulation in Patients Receiving Ultrasound-Assisted Catheter-Directed Thrombolysis for Treatment of Pulmonary Embolism

2018 ◽  
Vol 53 (5) ◽  
pp. 453-457
Author(s):  
Bradley P. St. Pierre ◽  
Stephanie B. Edwin
Keyword(s):  
Pulmonary Embolism ◽  
Retrospective Chart Review ◽  
Primary Objective ◽  
Bleeding Complications ◽  
Anticoagulation Management ◽  
Institutional Review ◽  
Catheter Directed Thrombolysis ◽  
Submassive Pulmonary Embolism ◽  
Ultrasound Assisted ◽  
Full Intensity

Background: Ultrasound-assisted, catheter-directed thrombolysis (USAT) has emerged as a popular treatment option for submassive pulmonary embolism (PE). The optimal strategy for transitioning patients from full-intensity to reduced-intensity heparin during the procedure has yet to be established. Objective: The goal of this study was to evaluate the anticoagulation management in patients receiving catheter-directed thrombolysis with USAT. Methods: A retrospective chart review was conducted of patients who received USAT for the treatment of PE. Institutional review board approval was obtained. The primary objective was to determine the proportion of patients with a therapeutic activated partial thromboplastin time (aPTT) prior to and during tissue-plasminogen activator (tPA) infusion. Secondary outcomes included heparin requirements, the rate of bleeding complications, and the appropriateness of long-term venous thromboembolism management. Results: A therapeutic aPTT value was achieved in 32 patients (54.2%) prior to USAT and 35 patients (59.3%) during tPA infusion. Heparin requirements were reduced from 15.1 ± 4.1 to 12.8 ± 4.2 U/kg/h for patients who achieved a therapeutic aPTT both prior to and during tPA infusion. Bleeding occurred in 34.4% of patients and tended to be minimal (20.3%) or minor (10.9%). The majority of patients were discharged on a direct oral anticoagulant (63%), followed by warfarin (32%) and enoxaparin (5%). Conclusion and Relevance: To our knowledge, this is the first study that has assessed heparin management in the setting of USAT. The results of these data may aid in empirically dose adjusting unfractionated heparin to ensure safe and effective anticoagulation for patients receiving USAT.

scholarly journals Pathogenesis and treatment of intracranial arachnoid cysts in pediatric patients younger than 2 years of age

2007 ◽  
Vol 22 (2) ◽  
pp. 1-5 ◽  
Author(s):  
Gabriel Zada ◽  
Mark D. Krieger ◽  
Sean A. McNatt ◽  
Ira Bowen ◽  
J. Gordon McComb
Keyword(s):  
Los Angeles ◽  
Arachnoid Cyst ◽  
Pediatric Patients ◽  
Clinical Signs ◽  
Retrospective Chart Review ◽  
Signs And Symptoms ◽  
Arachnoid Cysts ◽  
P Value ◽  
Clinical Signs And Symptoms

Object Arachnoid cysts can cause a variety of clinical signs and symptoms in infants. The authors sought to determine whether the clinical presentation of pediatric patients younger than 2 years old and harboring arachnoid cysts influenced the type of intervention that would be required. Methods A retrospective chart review was conducted for all patients younger than 2 years of age who had undergone craniotomy for fenestration of an arachnoid cyst at the Childrens Hospital Los Angeles between 1995 and 2006. Forty-two patients were included in the study. The mean age was 10.4 months. The median follow-up time was 33 months. Clinical presentations were as follows: macrocephaly without ventriculomegaly (21 patients, 50%), hydrocephalus (six patients, 14%), and other symptoms (15 patients, 36%). After fenestration of the arachnoid cyst, 12 of 21 patients (57%) presenting with nonspecific macrocephaly required placement of a cystoperitoneal or ventriculoperitoneal shunt, compared with 1 of 15 patients (7%) presenting with other symptoms (p value = 0.0039). Five of six patients with hydrocephalus (83%) were shunt dependent following fenestration. Overall, 18 of 42 patients (43%) were shunt dependent after fenestration. Ten of these patients (55%) required revisions during the follow-up period. Conclusions Patients younger than 2 years of age and harboring an arachnoid cyst commonly present with macrocephaly. These patients are more likely to require shunts than are those presenting with other findings, such as seizu

scholarly journals Successful Secondary Endovascular Intervention in Pediatric Patients with Venous Thromboembolic Events

2022 ◽  
Author(s):  
Hannah Glonnegger ◽  
Barbara Zieger ◽  
Jochen Grohmann ◽  
Gabriele Freund ◽  
Thomas Zeller ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Multidisciplinary Treatment ◽  
Clinical Signs ◽  
Endovascular Intervention ◽  
Postthrombotic Syndrome ◽  
Thromboembolic Events ◽  
Catheter Directed Thrombolysis ◽  
Venous Thromboembolic Events ◽  
Venous Thromboembolic

Abstract Background In the past, pediatric patients with venous thromboembolic events (VTE) were treated with low-molecular-weight heparin (LMWH) which was successful in around 70% of the cases. However, anticoagulation alone might not restore patency in all patients, and advanced therapeutic options to prevent postthrombotic syndrome are needed. During recent years, endovascular interventions have become a treatment option for pediatric patients with persistent thrombotic occlusion, not only in life- or limb-threatening VTE. Methods We evaluated 12 consecutive patients (11–17 years) with newly diagnosed VTE being treated at our department during the last 4 years (2017–2020). In case follow-up examination showed persistent venoocclusion under anticoagulation, patients received secondary interventional therapy like recanalization, percutaneous transluminal angioplasty with or without catheter-directed thrombolysis, and stenting. Patients with no clinical signs of venoocclusion or regredient thrombosis in imaging examination received anticoagulation alone. Results Six of 12 (50%) patients underwent catheter intervention. Median time from diagnosis to intervention was 4 months (0–12 months). Reintervention was necessary in one (8%) case and complete recanalization failed in one (8%) case. There were no major bleeding events or other major postinterventional complications, no acute or late local recurrence, and all patients reported clinical improvement after the procedure. Conclusion If endovascular intervention is used in teenage patients with persistent symptomatic VTE, reduction of postthrombotic symptoms is possible, even if intervention is performed secondary to failure of anticoagulation. Multidisciplinary treatment decisions can be based on the clinical course and follow-up imaging.

A new treatment paradigm for phlegmasia cerulea dolen: Single stage endovascular pharmacomechanical thrombectomy with venoplasty and stenting

2020 ◽  
pp. 026835552097727
Author(s):  
GuangMing Tan ◽  
Bryan PY Yan
Keyword(s):  
Clinical Success ◽  
Treatment Algorithm ◽  
Clinical Success Rate ◽  
Iliac Vein ◽  
Single Stage ◽  
Bleeding Complications ◽  
Common Iliac Vein ◽  
Period 2 ◽  
Treatment Paradigm ◽  
Iliac Vein Compression

Background Phlegmasia Cerulae Dolen (PCD) is potentially a lethal disease but there is currently no established treatment algorithm for it. The aim of this study was to assess the safety and effectiveness of single stage endovascular pharmacomechanical thrombectomy with venoplasty and stenting in the treatment of PCD. Method This was a retrospective single centre observational study of consecutive patients who underwent endovascular intervention for the treatment of PCD between June 2016 and March 2020. Clinical and procedural details were recorded. Procedural and clinical success rate, procedural complications, and 30 days mortality were reported. Result 11 patients were treated during the study period. 2 (18.2%) had active malignancy. 63.6% were uncomplicated PCD on presentation. Common iliac vein compression or stenosis were demonstrated in all patients. Venous stents were implanted in all cases and procedures were successful in all cases. All patients had symptoms improvement at 72 hours post procedure. Other than 2 major bleeding complications, there was no other adverse event. The 30 days mortality was 18.2%. Active malignancy and the presence of anaemia were significantly associated with major complications. Conclusion Single stage endovascular thrombectomy and stenting was effective and safe in the treatment of patients with PCD. Common Iliac vein compression was a common underlying cause of PCD.

scholarly journals 0897 Sleep Disordered Breathing In Pediatric Patients With Turner Syndrome

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A341-A342
Author(s):  
Y A Yu ◽  
B V Vaughn
Keyword(s):  
Sleep Apnea ◽  
Turner Syndrome ◽  
Sleep Disordered Breathing ◽  
Pediatric Patients ◽  
Genetic Disorder ◽  
Case Series ◽  
Growth Failure ◽  
Retrospective Chart Review ◽  
Upper Airway Resistance Syndrome ◽  
Disordered Breathing

Abstract Introduction Turner syndrome (TS) is a common genetic disorder that affects phenotypic females with partial or complete absence of one X chromosome. It typically presents with characteristic facial appearance, neck webbing, lymphedema, linear growth failure, and ovarian insufficiency. TS is also associated with other disorders, though sleep related disorders are not commonly reported. We present a case series of pediatric patients diagnosed with TS and assess their risk for sleep disordered breathing. Methods This study utilized retrospective chart review of the electronic medical record at the University of North Carolina at Chapel Hill from April 2014 to January 2019. Only pediatric patients under the age of 18 years who had previously undergone polysomnography and carrying the diagnosis of Turner syndrome were included in this study. Polysomnography results were reviewed. Results Retrospective chart analysis yielded ten (10) patients who qualified for inclusion. The mean age was 8.3 years (age range 1-15 years). Nine (9) patients were found to have sleep disordered breathing ranging from upper airway resistance syndrome to moderate sleep apnea (AHI range 1.2 to 6.2). Six (6) patients were found to have elevated periodic limb movement indices (PLM index range 5.1 to 30). Parasomnias and hypoventilation were not seen. Conclusion Our case series illustrates that sleep disordered breathing may be more common in TS than previously realized. Eklund et al. found that females with TS had more retrognathic mandibles and maxillas, shorter mandibles, and larger cranial base angles. These findings may indicate elevated risk of sleep apnea. Further studies are needed to define the overall risk of sleep disordered breathing in TS. Support None.

Sign in / Sign up

Export Citation Format

Share Document