Treatment of Catheter-Related Arterial Thrombosis in Children: A 15-Year Single- Center Experience

Crameri, Ornella; Brotschi, Barbara; Achini, Federica; Rizzi, Mattia; Albisetti, Manuela

doi:10.1016/j.jpeds.2021.08.035

Cited by 7 publications

(8 citation statements)

References 17 publications

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“…Crameri et al reported CR in 66% of their cohort within the first 6 weeks of treatment. 8 Cohen et al reported CR in 60.7% of cases after 28 days of anticoagulation. 7 Additionally, Glatz et al reported CR in 89% of patients after 12 weeks of therapy.…”

Section: Discussionmentioning

confidence: 97%

“…Prematurity and younger age were inconsistently reported as risk factors for catheter-related AT. 8,20,21 Cohen et al reported femoral or iliac AT as a predictor for CR. 7 In our analysis, extremity location did not seem to significantly affect the rate of CR.…”

Section: Discussionmentioning

confidence: 99%

“…7 Crameri et al reported a complete resolution of AT of 66% of their patient cohort at a median duration of 18 days with heparin alone. 8 These studies suggest extending anticoagulation might be beneficial in achieving complete resolution of AT. Nonetheless, the optimal intensity, duration, and modality of antithrombotic therapy for childhood AT are yet to be determined.…”

Section: Introductionmentioning

confidence: 97%

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Pediatric arterial thrombosis: A single‐institution cohort study of patient characteristics and thrombosis outcomes

Abdelghani,

Agarwal,

Stanek

et al. 2023

Pediatric Blood & Cancer

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BackgroundArterial thrombosis (AT) is an increasingly recognized complication in pediatrics. Consensus clinical practice guidelines suggest immediate removal of the indwelling arterial catheter and a short course (5‐7 days) of anticoagulation. The optimal duration and modality of antithrombotic therapy in children are yet to be determined.AimsDescribe treatment patterns and outcomes in pediatric patients with AT and explore predictors for complete thrombus resolution or long‐term complications.MethodsSingle‐institution retrospective study. Patients were identified by ICD‐9 and ICD‐10 codes for the diagnosis of AT or reports of AT on ultrasound from January 1, 2012, to October 1, 2022. Descriptive and logistic regression analyses were used.Results101 patients were included. The median age was 2.2 months. The most common underlying diagnoses were congenital heart disease (39.6%) and infection (22.8%). A majority of patients had symptomatic thrombosis in an extremity, and 78% were catheter‐associated. 81% of patients received anticoagulation with a median duration of 35 days. Out of the 70 patients who were treated with anticoagulation alone and had a follow‐up imaging, 70% had complete resolution after 90 days of anticoagulation. No clear predictors of complete resolution were identified. Eighteen patients had long‐term sequelae secondary to arterial insufficiency. Those with infection‐associated AT were more likely to have long‐term complications. The major and clinically relevant non‐major bleeding rate was 11%.ConclusionDuration of anticoagulation was widely variable, and 70% of patients achieved complete resolution by 90 days of anticoagulation. A significant proportion of patients developed long‐term sequelae secondary to arterial insufficiency. Sepsis/infection at the time of diagnosis with AT was more likely to be associated with long‐term complications.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 97%

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Pediatric arterial thrombosis: A single‐institution cohort study of patient characteristics and thrombosis outcomes

Abdelghani,

Agarwal,

Stanek

et al. 2023

Pediatric Blood & Cancer

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“…CVC use can prevent and reduce the pain and difficulty of repeated puncture, protect peripheral blood vessels, and provide rapid access for infusion, blood transfusion, and central venous pressure monitoring. Catheter-related thrombosis (CRT) is the most common complication of CVC (2). The incidence of CRT varies greatly among different races, ages, diseases, and medical institutions, with an incidence ranging from 2-81% in children with CVCs in different unit (3)(4)(5)(6)(7), and 20-66% in Chinese children with CVCs without prophylaxis (8,9).…”

Section: Introductionmentioning

confidence: 99%

Risk factors for central venous catheter-related thrombosis in hospitalized children: a single-center a retrospective cohort study

Li¹,

Luo

Deng³

et al. 2022

Transl Pediatr

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Background: This study aimed to explore the risk factors of catheter-related thrombosis (CRT) in children in Southwest China who underwent central venous catheter (CVC) insertion.Methods: An observational cohort study was conducted at a single tertiary center in southwest China between November 2019 and February 2020. All patients who received a CVC were enrolled and Doppler-ultrasound examination was performed weekly until CVC removal. All patients in this study were hospitalized and were observed and followed up in this hospital. Patient demographics, medication, biochemical indexes, catheter maintenance practice, activities after CVC placement data were analyzed. The Kaplan-Meier method was used to calculate the incidence of CRT, and the Cox regression model was used to analyze the factors influencing CRT.Results: A total of 594 children were included in the study, and the median indwelling time was 10 days, with the shortest being 1 day and the longest 60 days. The overall incidence of CRT was 26.60% (158/594), the 15-day cumulative incidence rate was 30.81%, and the 45-day cumulative incidence rate was 46.27%. After 45 days, the incidence of CRT further increased. Age <12 months [hazard ratio (HR), 1.654; 95%

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“…Compared with traditional surgery, its advantages include less trauma and faster postoperative recovery, but the complications after interventional occlusion should not be ignored. Catheter-related arterial thrombosis (CAT) is the damage to the vascular wall after the catheter is inserted into the artery, leading to the formation of intravascular thrombus [2] .…”

Section: Introductionmentioning

confidence: 99%

An unusual case of lower limb dysplasia with ulcer after interventional closure of PDA in childhood

Xie

et al. 2022

Preprint

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Background: Lower limb dysplasia is a rare complication after interventional closure of patent ductus arteriosus (PDA) in childhood. The most common treatment of PDA is interventional closure via femoral artery. Compared with traditional surgery, its advantages include less trauma and faster postoperative recovery, but the complications after interventional occlusion should not be ignored. Case presentation: A 10-year-old girl had redness and swelling of the toes of the right lower limb with skin ulceration on the medial side of the right foot for more than 4 months. She accepted interventional closure of PDA 7 years ago. Physical examination showed that the right foot was about 2 cm shorter than the left foot. We present a rare case of a young girl with lower limb dysplasia after interventional closure of PDA in childhood, Combined findings of Color Doppler ultrasound, Intravenous Ultrasound (IVUS), Computed tomography angiography (CTA) and Angiography, we found right foot developmental delay most likely was due to vascular injury after interventional closure of PDA in childhood. Conclusion: It is critical to understand not only the acute but also the long-term complications that may occur after interventional procedure. To avoid the development of vascular injury, it is advised that patients who underwent femoral artery catheterization for interventional treatment in their early years undergo strict clinical and imaging surveillance.

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Treatment of Catheter-Related Arterial Thrombosis in Children: A 15-Year Single- Center Experience

Cited by 7 publications

References 17 publications

Pediatric arterial thrombosis: A single‐institution cohort study of patient characteristics and thrombosis outcomes

Pediatric arterial thrombosis: A single‐institution cohort study of patient characteristics and thrombosis outcomes

Risk factors for central venous catheter-related thrombosis in hospitalized children: a single-center a retrospective cohort study

An unusual case of lower limb dysplasia with ulcer after interventional closure of PDA in childhood

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