TRANSCATHETER RECANALIZATION AND BALLOON DILATATION OF ARTERIAL THROMBOSIS IN PEDIATRIC PATIENTS

Peuster M, Fink C, Bökenkamp R, Jux C, Kaulitz R, Paul T, Hausdorf G

Department of Pediatric Cardiology and Pediatric Intensive Care, Hannover Medical School, Germany

OBJECTIVE: To evaluate the safety and patency rates of transcatheter recanalization of arterial thromboses in pediatric patients.

PATIENTS: 9 patients (age: 4 days - 19 months): tetralogy of Fallot (n=2), valvar aortic stenosis (n=2), pulmonary atresia (n=2), transposition of the great arteries (n=l), congenital thrombosis of the descending aorta (n=l) and activated protein c resistance with congenital thrombosis of the external iliac artery (n=l). In 7 patients the femoral (n=6) or subclavian (n=l) arterial thrombosis was due to arterial cardiac catheterization.

METHODS: 5 patients had recanalization using an antegrade femoral venous approach with passage to the arterial side via a ventricular septal defect (n=3) or the ductus arteriosus (n=2). 4 patients were treated using retrograde arterial catheterization via the axillary artery (n=2) or the femoral artery (n=2). The occluded vessels were recanalized using 0.018-in and 0.03 5-in guide wires. Coronary angioplasty catheters with diameters ranging from 2 mm to 4 mm were used in 8 patients, 1 patient was dilatated with a 5 mm angioplasty catheter. 1 to 15 dilatations with pressures ranging from 10 to 22 atm were performed.

RESULTS: There were no complications. Repeat angiography or duplex- sonography 1-6 months postinterventionally showed completely patent arteries without residual stenosis in 8 patients, 1 patient had partial recanalization.

CONCLUSION: Transcatheter recanalization of arterial thrombosis was safely performed in pediatric patients. It may be an effective alternative to fibrinolytic therapy.