Abstract：
BACKGROUND: Pediatric iliofemoral venous thromboembolism that is resistant to conventional treatments poses significant management challenges. Stent placement represents a potentially underutilized strategy in children when stenosis or thrombosis persists intraprocedurally or recurs postoperatively, despite treatments such as venoplasty, lysis, and thrombectomy.
OBJECTIVE: This study aims to report our institutional experience with iliofemoral stenting in 17 pediatric patients with recurrent iliofemoral venous thromboembolism or stenosis.
METHODS: We performed an IRB-approved retrospective review of pediatric patients (<18 years of age) who underwent iliofemoral venous stenting for recurrent stenosis or thrombosis between January 2012 and December 2022 at a single tertiary care institution. Patient demographics, risk factors for venous thromboembolism, presenting symptoms, and procedural characteristics were recorded. The primary outcome was stent patency rates at interval imaging follow-up.
RESULTS: Seventeen patients with mean age of 14.6 years (range 7-17) and mean BMI of 27.7 were stented during the study period. Sixteen of 17 patients presented with evidence of May-Thurner anatomy. 14/17 patients presented with acute iliofemoral venous thromboembolism, 2/17 with chronic venous thromboembolism, and 1/17 with left lower extremity swelling without thrombosis. Seventy-three total angiographic procedures were performed, which included angioplasty, lysis, and thrombectomy, and 23 stent placements. Patients underwent an average of 3 procedures (range 1-9) over a mean of 2.8 months (range 0-17 months) prior to undergoing stent placement. Stents were deployed successfully in all patients. The median follow-up was 18 months (range, 1-77 months). Primary and secondary patency rates were 13/17 (76%) and 14/14 (100%) at 12 months and 12/17 (71%) and 14/14 (100%) at 24 months, respectively.
CONCLUSIONS: In our experience of 17 patients, stent placement appears to be a durable option for children with iliofemoral venous thromboembolism following failure to establish vessel patency or development of recurrent thrombosis/stenosis postoperatively.
OBJECTIVE: This study aims to report our institutional experience with iliofemoral stenting in 17 pediatric patients with recurrent iliofemoral venous thromboembolism or stenosis.
METHODS: We performed an IRB-approved retrospective review of pediatric patients (<18 years of age) who underwent iliofemoral venous stenting for recurrent stenosis or thrombosis between January 2012 and December 2022 at a single tertiary care institution. Patient demographics, risk factors for venous thromboembolism, presenting symptoms, and procedural characteristics were recorded. The primary outcome was stent patency rates at interval imaging follow-up.
RESULTS: Seventeen patients with mean age of 14.6 years (range 7-17) and mean BMI of 27.7 were stented during the study period. Sixteen of 17 patients presented with evidence of May-Thurner anatomy. 14/17 patients presented with acute iliofemoral venous thromboembolism, 2/17 with chronic venous thromboembolism, and 1/17 with left lower extremity swelling without thrombosis. Seventy-three total angiographic procedures were performed, which included angioplasty, lysis, and thrombectomy, and 23 stent placements. Patients underwent an average of 3 procedures (range 1-9) over a mean of 2.8 months (range 0-17 months) prior to undergoing stent placement. Stents were deployed successfully in all patients. The median follow-up was 18 months (range, 1-77 months). Primary and secondary patency rates were 13/17 (76%) and 14/14 (100%) at 12 months and 12/17 (71%) and 14/14 (100%) at 24 months, respectively.
CONCLUSIONS: In our experience of 17 patients, stent placement appears to be a durable option for children with iliofemoral venous thromboembolism following failure to establish vessel patency or development of recurrent thrombosis/stenosis postoperatively.
摘要：
背景：对常规治疗具有抗性的小儿髂股静脉血栓栓塞带来了重大的管理挑战。当狭窄或血栓形成持续存在于术中或术后复发时，支架放置是儿童潜在未充分利用的策略。尽管静脉成形术等治疗方法，裂解，和血栓切除术.
目的：本研究旨在报告我们在17例复发性髂股静脉血栓栓塞或狭窄的儿科患者中进行髂股静脉支架置入术的机构经验。
方法：我们对2012年1月至2022年12月在一家三级医疗机构接受髂股静脉支架置入治疗复发性狭窄或血栓形成的儿科患者（<18岁）进行了IRB批准的回顾性研究。患者人口统计学，静脉血栓栓塞的危险因素，出现症状，并记录程序特征。主要结果是间隔成像随访时的支架通畅率。
结果：在研究期间，17名平均年龄为14.6岁（范围7-17）和平均BMI为27.7的患者被置入支架。17例患者中有16例表现出May-Thurner解剖的证据。14/17例患者出现急性髂股静脉血栓栓塞，2/17慢性静脉血栓栓塞症，1/17伴左下肢肿胀，无血栓形成。总共进行了73次血管造影手术，其中包括血管成形术，裂解，和血栓切除术,和23个支架放置。在进行支架置入之前，患者在平均2.8个月（范围0-17个月）内平均进行了3次手术（范围1-9）。所有患者均成功部署支架。中位随访时间为18个月(范围，1-77个月）。主要和次要通畅率在12个月时分别为13/17（76％）和14/14（100％），在24个月时分别为12/17（71％）和14/14（100％）。分别。
结论：根据我们对17例患者的经验，对于未能建立血管通畅或术后复发性血栓形成/狭窄的儿童，支架置入似乎是一种持久的选择。
目的：本研究旨在报告我们在17例复发性髂股静脉血栓栓塞或狭窄的儿科患者中进行髂股静脉支架置入术的机构经验。
方法：我们对2012年1月至2022年12月在一家三级医疗机构接受髂股静脉支架置入治疗复发性狭窄或血栓形成的儿科患者（<18岁）进行了IRB批准的回顾性研究。患者人口统计学，静脉血栓栓塞的危险因素，出现症状，并记录程序特征。主要结果是间隔成像随访时的支架通畅率。
结果：在研究期间，17名平均年龄为14.6岁（范围7-17）和平均BMI为27.7的患者被置入支架。17例患者中有16例表现出May-Thurner解剖的证据。14/17例患者出现急性髂股静脉血栓栓塞，2/17慢性静脉血栓栓塞症，1/17伴左下肢肿胀，无血栓形成。总共进行了73次血管造影手术，其中包括血管成形术，裂解，和血栓切除术,和23个支架放置。在进行支架置入之前，患者在平均2.8个月（范围0-17个月）内平均进行了3次手术（范围1-9）。所有患者均成功部署支架。中位随访时间为18个月(范围，1-77个月）。主要和次要通畅率在12个月时分别为13/17（76％）和14/14（100％），在24个月时分别为12/17（71％）和14/14（100％）。分别。
结论：根据我们对17例患者的经验，对于未能建立血管通畅或术后复发性血栓形成/狭窄的儿童，支架置入似乎是一种持久的选择。
