Long term complications of inferior vena cava thrombosis
Long term complications of inferior vena cava thrombosis
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DOI：
10.1136/adc.85.3.228
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发表时间：
2001-09-01
影响因子：
5.2
通讯作者：
Mühler, EG
中科院分区：
文献类型：
--
作者：
Häusler, M;Hübner, D;Mühler, EG
目的：评价小儿下腔静脉血栓形成后的长期预后。方法：对1980年至1999年在亚琛和马斯特里赫特大学医院治疗的婴儿和儿童IVC血栓形成进行回顾性和前瞻性研究。结果：40例患者入组，包括4例既往心导管，18例中心静脉隐静脉，另外8例脐静脉导管。6名患者在确诊后3个月内死亡；1例患者失访。其余33例患者中有12例患有有限的下腔静脉血栓；在长达9年的随访中，没有人显示出持续的腔静脉阻塞（成功溶栓，n = 2；自发再通，n = 10）。其余21例患者出现广泛的下腔静脉血栓形成。在长达18年的随访中，只有4例患者发现血管完全恢复（1例溶栓，2例手术，1例自发再通）。17例患者发生持续髂和/或腔静脉阻塞，其中6例溶栓。12例发现静脉曲张，其中7例发现血栓形成后综合征。根据Kaplan-Meier分析，30%的持续性静脉疾病患者在血栓事件发生后10年内会出现血栓后综合征。结论：婴儿和儿童广泛的下腔静脉血栓形成是持续性静脉疾病和严重长期并发症的高危人群。迫切需要前瞻性试验来建立有效的治疗策略和改善长期预后。中心静脉导管，在这里报道的大多数病例中导致下腔静脉血栓形成，应仅在必要时插入。
Aim-To evaluate the long term outcome after paediatric inferior vena cava (IVC) thrombosis.Methods-A combined retrospective and prospective study on infants and children with IVC thrombosis treated at Aachen and Maastricht University Hospitals between 1980 and 1999.Results-Forty patients were enrolled, including four with preceding cardiac catheterisation, 18 with central venous saphenous lines, and an additional eight with umbilical venous catheters. Six patients died within three months of diagnosis; one patient was lost to follow up. Twelve of the remaining 33 patients had suffered from limited IVC thrombosis; during follow up (for up to nine years) none showed persisting caval obstruction (successful thrombolysis, n = 2; spontaneous recanalisation, n = 10). The remaining 21 patients presented with extensive IVC thrombosis. During follow up (for up to 18 years) complete restitution was found in only four cases (one thrombolysis, two surgery, one spontaneous recanalisation). Persisting iliac and/or caval venous obstruction occurred in 17 patients, including six with thrombolysis. Varicose veins were found in 12, and postthrombotic syndrome in seven of these cases. According to Kaplan-Meier analysis, 30% of patients with persisting venous disease will develop post-thrombotic syndrome within 10 years of the thrombotic event.Conclusions-Infants and children with extensive IVC thrombosis are at high risk for persisting venous disease and serious long term complications. Prospective trials are urgently needed to establish effective treatment strategies and to improve long term prognosis. Central venous catheters, contributing to IVC thrombosis in the majority of cases reported here, should be inserted only if essential.