Abstract Number: PB0789
Meeting: ISTH 2021 Congress
Background: Children with May-Thurner Syndrome (MTS), classified as compression of iliac vein by iliac artery, have higher likelihood of experiencing lower extremity deep vein thrombosis (LEDVT). There is limited pediatric literature describing MTS associated LEDVT.
Aims: To describe presentation, diagnosis, management and outcomes of MTS associated LEDVT in the pediatric population.
Methods: Retrospective chart review of patients 18 years of age with MTS associated LEDVT seen at McMaster Children’s Hospital between 2008-2020.
Results: During the study period, there were 16 patients (M: 5, F: 11, median age: 15.5 years, range: 13-18 years) with MTS and LEDVT. Common presenting symptoms were pain, swelling, and skin changes —observed in 15(94%), 12(75%), and 6(37.5%), patients respectively. There were 2 (12.5%) patients who presented with pulmonary embolism confirmed on imaging. Common risk factors were thrombophilia (68.8%), OCP (56.25%), surgery (12.5%), obesity (6.25%), and pro-longed non-ambulatory period (6.25%). Among the 11 patients with thrombophilia, most common conditions were factor V Leiden mutation (27.3%), prothrombin gene mutation (18.2%), protein C deficiency (9.1%), and protein S deficiency (9.09%). All patients were initially managed with anticoagulation alone, with low molecular weight heparin (81%) being most common agent. One patient was treated with catheter directed thrombolysis on recurrence. One patient (6.3%) had clot recurrence. Out of remaining 15 patients,14 had available follow-up imaging. Complete resolution, partial resolution, and stable thrombosis was observed in 3(21.4%), 6(42.9%), and 5(35.7%), respectively. The median treatment length was 7.4 months, while 6 patients (37.5%) were on indefinite long-term anticoagulation for preventing recurrence.
Conclusions: MTS associated LEDVT commonly presents in adolescent age group and is commonly associated with thrombophilia. Like adults, the risk of recurrence was low in our small cohort of pediatric patients with anticoagulation therapy for MTS associated LEDVT.
To cite this abstract in AMA style:Patel V, Stein N, Elias F, Chan AK, Bhatt M. Management of Iliofemoral Deep Vein Thrombosis (DVT) in Pediatric Patients in the Context of May-Thurner Syndrome (MTS) [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/management-of-iliofemoral-deep-vein-thrombosis-dvt-in-pediatric-patients-in-the-context-of-may-thurner-syndrome-mts/. Accessed June 25, 2022.
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