Use of Ultrasound-Accelerated, Catheter-Directed Local Thrombolysis for Venous and Arterial Occlusions in a Pediatric Hospital.

OBJECTIVES: Acute vascular thrombosis is associated with significant morbidity and mortality in children. Traditional therapies with angioplasty and manual aspiration thrombectomy are described in the pediatric population; however, data regarding the use of ultrasound-assisted catheter-directed thrombolysis in a pediatric hospital are lacking.

METHODS: All patients treated at our center with ultrasound-assisted catheter-directed thrombolysis from 2014-2018 were reviewed.

RESULTS: Ten patients with systemic venous (n = 5), pulmonary artery (n = 4), and systemic arterial (n = 1) were treated (20 total vessels), including 2 adults post Fontan palliation. The median age was 11.2 years (range, 9 months to 34.2 years) and median weight was 46.6 kg (range, 6.81-01.6 kg). Therapy was not completed in 1 patient. Significant improvement in clot burden/symptomatic improvement was seen in 8 patients (no improvement seen in 1 patient with acute and chronic thrombosis). There were no major bleeding or neurologic complications related to therapy.

CONCLUSIONS: The use of ultrasound-assisted catheter-directed thrombolysis in a pediatric center is a valuable modality for treating acute thrombosis with an acceptable safety profile.