Background: Deep vein thrombosis (DVT) of the lower extremity is rare in children and most of
them or history of CVC placement. The therapy includes anticoagulation, systemic thrombolysis
and, in rare cases, thrombectomy. Systemic thrombolysis with TPA has been used to
treat patients who do not respond to anticoagulation and those with extensive DVT.
Thrombo-aspiration with penumbra/Indigo System is a safe and effective treatment for
adult patient with ALI, PE, and AVF thrombosis. We report of the case of an adolescent
with DVT in the left lower extremity who underwent thrombo-aspiration with Indigo
System. Method(s): A 14-year-old boy, with previous RFA for wolff-parkinson-white syndrome, with DVT
of left popliteal, superficial, common femoral, and iliac veins not responding to
anticoagulation underwent thrombo-aspiration with indigo system. After US-guided puncture
of the popliteal vein, the dilator (3f) of a micropuncture set kit was positioned.
An 0.018 guidewire was advanced along the venous axis, and the dilator was changed
for an 8f sheath. Before starting the aspiration, a removable caval filter was positioned.
Venography after the aspiration revealed partial recanalization of the left venous
axis. Locoregional thrombolysis was performed with 0.6 mg of TPA. There were not complications
during any phase of treatment. Anticoagulant therapy was administered. Result(s): One week after the procedure, the swelling of the left lower extremity had resolved
completely. Caval filter was removed three months later. Duplex us at 1, 3 and 6 months
confirmed recanalization of popliteal, common femoral and iliac veins and only residual
thrombosis of the superficial femoral vein. The patient had no symptoms. Conclusion(s): DVT mechanical aspiration can be safe and effective to treat acute DVT of the lower
extremity in older children and adolescents. Thrombo-aspiration before thrombolysis
helps to decrease the thrombus burden, improve outflow for effective thrombolysis,
and reduce the dose of thrombolytic required.
