Abstract No. 96: Efficacy of lower extremity deep venous thrombolysis in the setting of congenital absence or atresia of the inferior vena cava

Abstract No. 96: Efficacy of lower extremity deep venous thrombolysis in the setting of congenital absence or atresia of the inferior vena cava

JVIR 䡲 Scientific Sessions Monday 䡲 S43 8:48 AM Abstract No. 95 Central venous access in high-risk pediatric patients: Comparison of conventional ...

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JVIR 䡲 Scientific Sessions

Monday 䡲 S43

8:48 AM

Abstract No. 95

Central venous access in high-risk pediatric patients: Comparison of conventional and antibiotic-impregnated catheters K.M. Baskin, M. Beck, C. Hunnicutt, F.A. Escobar, J. Crowley, C. Fitz; Interventional Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA Purpose: To determine whether there may be a significant clinical advantage to the selective use of antibiotic-impregnated catheters in children who require central venous access. Materials and Methods: From 12/08 to 6/09, there were 150 encounters with 124 children in high-risk categories for central venous access related infections in the Interventional Radiology service of a major metropolitan children’s hospital. Catheter assignment was made by the operator in each case. Seven children had encounters in both groups: antibiotic impregnated catheters (AC) and conventional catheters (CC). Encounters were retrospectively reviewed using electronic medical records, PACS, the IR database and telephone interviews with parents or primary providers. The following elements were included: demographics, diagnostic category, indication, catheter and insertion procedure characteristics, complications, and date and reason for removal. Statistical analysis included comparative evaluation of patient characteristics, outcomes, procedure duration, and catheter halflife between the two groups; AC (n⫽63) and CC (n⫽87). Results: There were no significant differences in the characteristics of children receiving the two types of catheter. There was greater than 4 times increase in risk of catheter-related infection in the CC group compared to the AC group, independent of whether the patient had an active infection at the time of catheter insertion. Catheter half-life, procedure time and mechanical complications were significantly greater in the AC group. Conclusion: This retrospective analysis suggests a significant role for antibiotic impregnated catheters in children at high risk of catheter-related infection, including those with short bowel syn-

drome; liver, small bowel or multivisceral transplant; renal failure; complex congential heart disease; active infection; or ICU admission. Prospective multiinstitutional study is necessary to further define the populations at risk and the potential clinical and economic benefits of such a stratified approach.

9:00 AM

Abstract No. 96

Efficacy of lower extremity deep venous thrombolysis in the setting of congenital absence or atresia of the inferior vena cava S. Ganguli1, S.P. Kalva1, N. Datta1, G. Walker1, E.F. Grabowski2, S. Wicky1; 1Vascular Imaging & Intervention, Massachusetts General Hospital/Harvard Medical School, Boston, MA; 2Pediatric Hematology & Oncology, Masschusetts General Hospital/Harvard Medical School, Boston, MA Purpose: A rare but described risk factor for DVT, predominately in younger patients, is congenital agenesis/atresia of the inferior vena cava (IVC). The optimal management including the technique, efficacy and outcomes of lower extremity thrombolysis for DVT in this subset of patients is unknown. We evaluate the efficacy of pharmacomechanical thrombolysis followed by systemic anticoagulation in the treatment of acute lower extremity DVT in the setting of congenital IVC agenesis or atresia. Materials and Methods: Between 11/05 and 5/10, five patients (range 15–30 yrs, avg 21 yrs, 3 females) were referred to our department with acute lower extremity DVT (3 bilateral), and also found to have IVC agenesis or atresia on MRI. A standardized technique for pharmacomechanical thrombolysis was used utilizing pharmacomechanical thrombolysis (AngioJet™) followed by overnight placement of a thrombolysis catheter (EKOS MicroSonic™ Thrombolysis system). Successful thrombolysis was followed by systemic heparinization with a transition to warfarin with a target INR of 2.5–3.0 and compression stockings. Subjects were followed at one-month, three months, and every 6 months post-procedure with clinical assessment and bilateral lower extremity venous ultrasound. Results: All pharmacomechanical thrombolysis procedures were technically successful with complete (n⫽4) or partial (n⫽1) resolution of DVT. In all patients, the venous drainage was through lumbar collaterals in the abdomen. No venous stenting was performed. The average thrombolysis time was 44.8 hours (range 12–96). Two patients were found to be allergic to heparin with heparin-induced thrombocytopenia, leading to the use of nonheparin anti-coagulation (argatroban) in these patients. No patients were lost to follow-up. The average length of follow-up was 29.9 months (range 3.8 –54.8). No incidence of recurrent deep vein thrombosis was identified. There were no manifestations of postthrombotic syndrome over this time course. Conclusion: Pharmacomechanical thrombolysis followed by systemic anticoagulation and compression stockings appears to be safe and effective in long term follow up in treating patients who present with acute deep vein thrombosis and IVC agenesis or atresia.

9:12 AM

Abstract No. 97

Hemodinamically unstable massive pulmonary embolism: Fibrinolysis in situ and fragmentation as treatment of choice

MONDAY: Scientific Sessions

nutrient flow for a period of 24 hours followed by sonication and quantitative recovery (ASTM E2562-07). For extended performance, samples were exposed for 56 days to 100% citrated human plasma at 37oC with weekly exchanges. A 90-day study with exposure to 50% fetal bovine serum at 37oC with weekly exchanges was also performed. Additionally, samples were tested in an industry standard 2-hour bovine flow loop thrombosis model. Thrombus was measured visually and quantitatively using radiolabeled platelet counts after 56 days of plasma exposure. Results: The betaine modified polymers showed equivalent reductions in S. epidermidis biofilm attachment (96.8%) before and after 56 days of plasma exposure. They also showed a consistent 99% reduction in radiolabeled platelet attachment in a thrombosis model. After 90 days of serum exposure a 98.9% reduction in E. coli biofilm was measured using a comparable mCDC reactor, demonstrating a further prolonged effectiveness and broad-spectrum activity. Conclusion: Betaine modified catheters demonstrated broadspectrum reduction in biofilm growth and thrombosis over 56 –90 days of blood product exposure. The devices will be assessed in clinical trials, targeting the reduction in vascular access catheterrelated complications over a chronic time period.