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Lower extremity endovenous reconstruction for symptomatic occlusive disease in pediatric patients: techniques, clinical outcomes, and long-term stent patencies

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Abstract

Background

Endovascular stent reconstruction is the standard of care for chronic venous occlusive disease in adults, but it has not been reported in pediatric patients.

Objective

This study reports the technical success, complications, clinical outcomes, and stent patency of iliocaval stent reconstruction for chronic iliocaval thrombosis in pediatric patients.

Materials and methods

Fourteen patients, 13 (93%) male with a mean age of 16.4 years (range: 8–20 years), underwent iliocaval stent reconstruction for chronic iliocaval thrombosis. The mean number of prothrombotic risk factors was 2.5 (range: 0–4), including 7 (50%) patients with inferior vena cava atresia. At initial presentation, the Clinical, Etiology, Anatomy, and Pathophysiology classification (CEAP) score was C3 in 2 (14%) patients, C4 in 11 (79%) patients, and C6 in 1 (7.1%) patient. Time course of presenting symptoms included chronic (>4 weeks) (n=7; 50%) and acute worsening of chronic symptoms (2–4 weeks) (n=7; 50%). Aspects of recanalization and reconstruction, stenting technical success, complications, clinical outcomes and stent patency were recorded. Clinical success was defined as a 1-point decrease in the CEAP. Primary, primary-assisted, and secondary patency were defined by Cardiovascular and Interventional Radiological Society of Europe guidelines.

Results

Most procedures employed three access sites (range: 2–4). Intravascular ultrasound was employed in 11 (79%) procedures. Blunt and sharp recanalization techniques were used in 12 (86%) and 2 (14%) patients, respectively. Stenting technical success was 100%. Two (14%) minor adverse events occurred and mean post-procedure hospitalization was 2.8 days (range: 1–8 days). Clinical success rates at 2 weeks, 6 months and 12 months were 85%, 82%, and 83%, respectively. At a mean final clinical follow-up of 88 months (range: 16–231 months), clinical success was 93%. Estimated 6- and 12-month primary stent patencies were 86% and 64%, respectively. Six- and 12-month primary-assisted and secondary stent patency rates were both 100%.

Conclusion

Iliocaval stent reconstruction is an effective treatment for symptomatic chronic iliocaval thrombosis in pediatric patients with high rates of technical success, 6- and 12-month clinical success, and 6- and 12-month primary-assisted and secondary patency rates.

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Authors and Affiliations

  1. Department of Radiology, Division of Vascular and Interventional Radiology, The University of Texas Southwestern Medical Center, Dallas, TX, USA

    Joseph L. McDevitt

  2. Department of Radiology, Division of Interventional Radiology, University of California, Los Angeles, Los Angeles, CA, USA

    Ravi N. Srinivasa

  3. Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA

    Anthony N. Hage

  4. Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Health System, Ann Arbor, MI, USA

    Jacob J. Bundy & Joseph J. Gemmete

  5. Cardiovascular and Interventional Radiology, Inova Alexandria Hospital, 4320 Seminary Road, Alexandria, VA, USA

    Jeffrey Forris Beecham Chick

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  1. Joseph L. McDevitt
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  2. Ravi N. Srinivasa
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  3. Anthony N. Hage
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  4. Jacob J. Bundy
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  5. Joseph J. Gemmete
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Correspondence to Jeffrey Forris Beecham Chick.

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McDevitt, J.L., Srinivasa, R.N., Hage, A.N. et al. Lower extremity endovenous reconstruction for symptomatic occlusive disease in pediatric patients: techniques, clinical outcomes, and long-term stent patencies. Pediatr Radiol 49, 808–818 (2019). https://doi.org/10.1007/s00247-019-04357-w

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  • DOI: https://doi.org/10.1007/s00247-019-04357-w

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