Catheter-Directed Thrombolysis for Portal Vein Thrombosis in Children: A Case Series

Abstract

Purpose: To describe safety and efficacy of catheter-directed thrombolysis (CDT) for portal vein thrombosis (PVT) in children.

Materials and methods: Retrospective review was performed of 10 consecutive patients (7 girls, 3 boys; mean age 11.9 y; range, 3-17 y) with PVT undergoing CDT at a single tertiary children's hospital between August 2005 and March 2016. PVT was categorized by etiology and extent (intrahepatic, extrahepatic, or both). CDT was performed with infusion catheters placed via percutaneous transhepatic (PTH) and/or transjugular intrahepatic (TJ) approaches, with or without the use of adjunctive maneuvers, including balloon maceration and suction and rheolytic thrombectomy. Degree of thrombolysis on portal venography, presence of portal vein thrombus on available follow-up imaging, and complication rates were recorded.

Results: In 10 patients, 13 CDT procedures were performed for PVT, with 3 patients requiring repeat CDT. Portal access was achieved with PTH (n = 6), TJ (n = 2), or combined (n = 2) approaches. All cases were successful in re-establishing patency and hepatopetal flow on portal venography with complete thrombolysis achieved in 10 of 13 cases (77%). Two major complications (20%) occurred, both with PTH access. Mean follow-up time for 9 patients was 2.6 years (range, 51-1,902 d) with long-term patency achieved in 6 (67%).

Conclusions: CDT can be safe and effective for PVT in children. Portal access considerations and early initiation of thrombolysis may further increase safety and efficacy.