Ultrasound Assisted Endovascular Thrombolysis in Adolescents: 2 Case Reports

A review into the management of May-Thurner syndrome in adolescents

OBJECTIVE

To investigate the presentation, etiology, management and outcomes of May-Thurner syndrome (MTS) in adolescents aged under 18.

METHODS

We searched electronic bibliographic databases to identify published reports of MTS in patients under 18 years of age. We conducted our review according to the PRISMA statement standards.

RESULTS

Ten studies encompassing 22 patients treated for MTS in adolescent cases were identified. The mean age of patients was 15 years (range, 10-18 years). Of the 22 patients, 12 (55%) were confirmed to have proximal deep vein thrombosis as the primary indication for intervention. Treatment methods included catheter-directed thrombolysis and iliac vein stenting (41%), pharmacomechanical thrombolysis and iliac vein stenting (18%), iliac vein stenting alone (27%), open surgery (14%), catheter-directed thrombolysis (5%), and anticoagulation alone (5%). Complications were infrequent. All studies reported subjective improvements in clinical symptoms with only two studies using validate outcome measures. In total, 9 of 22 patients (41%) had addition risk factors that may precipitate thrombosis.

CONCLUSIONS

As in adults, the most common form of treatment seen in the literature is a combination of catheter direct thrombolysis, followed by iliac vein stenting with subsequent anticoagulation. Complications from interventions were low. It is unclear how these interventions affect symptomology and the long-term sequalae associated endovascular surgery and stenting in adolescents. Further research is needed in well-designed studies with adequate follow-up.

A series of 10 Polish patients with thromboembolic events and antithrombin deficiency: two new c.1154-1 G>C and c.1219-534 A>G SERPINC1 gene splicing mutations

: Inherited antithrombin (AT) deficiency, with prevalence in the general population ranging 0.02-0.17%, is an autosomal dominant disorder associated with a high risk of venous thromboembolism. In most cases, deficiency is caused by mutations in the AT-coding gene (SERPINC1). Only 24 splicing defects have been described causing AT deficiency, all affecting exon flanking regions. The aim of the current study was to characterize the mutations underlying AT deficiency in 10 venous thromboembolism Polish patients aged 42.9 (14-63) years. Whole SERPINC1 gene sequencing was done by next generation sequencing methods. Eight cases had mutations previously described. However, we identified two new intronic mutations that might affect the correct splicing of exon 6 according to in-silico predictions: c.1154-1 G>C, which strongly disturbs the acceptor sequence and c.1219-534 A>G, a deep intronic mutation that might generate a cryptic donor sequence; both might compete with the wild-type donor sequence and explain the associated moderate AT deficiency of carriers. In conclusion, we show the molecular base of AT deficiency in 10 new Polish patients, including two novel SERPINC1 gene mutations potentially affecting splicing.