{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T10:39:50Z","timestamp":1789468790228,"version":"build-2803163510"},"reference-count":45,"publisher":"Georg Thieme Verlag KG","issue":"03","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Semin intervent Radiol"],"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>This study aims to review current practices in thrombolysis and thrombectomy for managing deep venous thrombosis (DVT) and associated complications in the pediatric population. Pediatric thrombosis care has a rich history of evolution, from the early days of anticoagulation to the current era of endovascular therapies. This evolution has been driven by the need for a nuanced, multidisciplinary approach that includes interventional radiology (IR) and hematology. While anticoagulation remains the standard of care, endovascular therapies are increasingly utilized in cases of extensive, occlusive, or limb-threatening DVT, particularly to prevent pulmonary embolism and postthrombotic syndrome (PTS) and to preserve venous patency. This review outlines the indications, contraindications, and procedural techniques for catheter-directed thrombolysis, pharmaco-mechanical thrombectomy (PMT), mechanical thrombectomy, and venous stenting in children. It emphasizes the crucial role of a multidisciplinary team, including pediatric hematologists, interventional radiologists, and other medical professionals, in managing pediatric DVT. This collaboration is essential for considering pediatric-specific factors such as patient size, sedation requirements, radiation, contrast dosing, and anticoagulation. Also highlighted are postprocedural care, anticoagulation strategies, and imaging follow-up. Multidisciplinary collaboration is critical to improving outcomes for children with thrombotic disease.<\/jats:p>","DOI":"10.1055\/s-0045-1811718","type":"journal-article","created":{"date-parts":[[2025,9,25]],"date-time":"2025-09-25T22:43:40Z","timestamp":1758840220000},"page":"313-323","source":"Crossref","is-referenced-by-count":1,"title":["Endovascular Management of Pediatric Deep Venous Thrombosis"],"prefix":"10.1055","volume":"42","author":[{"given":"Vaz","family":"Zavaletta","sequence":"additional","affiliation":[{"name":"Division of Pediatric Radiology, Department of Radiology, University of Colorado, Children's Hospital Colorado, Aurora, Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beth B.","family":"Warren","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Hemophilia and Thrombosis Center, University of Colorado, Anschutz Medical Campus, Aurora, Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danielle","family":"Katz","sequence":"additional","affiliation":[{"name":"Division of Pediatric Radiology, Department of Radiology, University of Colorado, Children's Hospital Colorado, Aurora, Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grace","family":"Eliason","sequence":"additional","affiliation":[{"name":"Department of Radiology, University of Colorado, Aurora, Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Collard","sequence":"additional","affiliation":[{"name":"Division of Pediatric Radiology, Department of Radiology, University of Colorado, Children's Hospital Colorado, Aurora, Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aparna","family":"Annam","sequence":"additional","affiliation":[{"name":"Division of Pediatric Radiology, Department of Radiology, University of Colorado, Children's Hospital Colorado, Aurora, Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2025,9,25]]},"reference":[{"issue":"22","key":"ref1","doi-asserted-by":"crossref","first-page":"3292","DOI":"10.1182\/bloodadvances.2018024786","article-title":"American Society of Hematology 2018 Guidelines for management of venous thromboembolism: treatment of pediatric venous thromboembolism","volume":"2","author":"P Monagle","year":"2018","journal-title":"Blood Adv"},{"issue":"02","key":"ref2","doi-asserted-by":"crossref","first-page":"651","DOI":"10.1016\/j.jtha.2024.09.038","article-title":"Duration of anticoagulation for venous thromboembolism in pediatric patients: evaluation of the duration of therapy for thrombosis in children (Kids-DOTT) trial outcomes at 2 years","volume":"23","author":"N A Goldenberg","year":"2025","journal-title":"J Thromb Haemost"},{"issue":"02","key":"ref3","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1542\/pir.2019-0026","article-title":"Venous thromboembolism in pediatrics","volume":"42","author":"J Shoag","year":"2021","journal-title":"Pediatr Rev"},{"issue":"04","key":"ref4","doi-asserted-by":"crossref","first-page":"1001","DOI":"10.1542\/peds.2009-0768","article-title":"Dramatic increase in venous thromboembolism in children's hospitals in the United States from 2001 to 2007","volume":"124","author":"L Raffini","year":"2009","journal-title":"Pediatrics"},{"issue":"03","key":"ref5","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.26881","article-title":"Deep vein thrombosis in pediatric patients","volume":"65","author":"J Jaffray","year":"2018","journal-title":"Pediatr Blood Cancer"},{"key":"ref6","doi-asserted-by":"crossref","first-page":"5","DOI":"10.3389\/fped.2017.00005","article-title":"The impact of central venous catheters on pediatric venous thromboembolism","volume":"5","author":"J Jaffray","year":"2017","journal-title":"Front Pediatr"},{"issue":"04","key":"ref7","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1053\/j.ro.2019.06.003","article-title":"The role of interventional radiology in the treatment of acute thrombosis and chronic veno-occlusive disease in children and adolescents","volume":"54","author":"A E Gill","year":"2019","journal-title":"Semin Roentgenol"},{"key":"ref8","doi-asserted-by":"crossref","first-page":"260","DOI":"10.3389\/fped.2017.00260","article-title":"Pediatric thrombolysis: a practical approach","volume":"5","author":"C Tarango","year":"2017","journal-title":"Front Pediatr"},{"issue":"01","key":"ref9","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1007\/s00270-023-03628-2","article-title":"Technical feasibility and clinical efficacy of iliac vein stent placement in adolescents and young adults with May-Thurner syndrome","volume":"47","author":"F J Bertino","year":"2024","journal-title":"Cardiovasc Intervent Radiol"},{"issue":"05","key":"ref10","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1007\/s00247-014-3209-4","article-title":"Outcomes in children with deep vein thrombosis managed with percutaneous endovascular thrombolysis","volume":"45","author":"C E Dandoy","year":"2015","journal-title":"Pediatr Radiol"},{"issue":"01","key":"ref11","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1016\/j.jvir.2016.09.005","article-title":"Endovascular management of May-Thurner syndrome in adolescents: a single-center experience","volume":"28","author":"R E Goldman","year":"2017","journal-title":"J Vasc Interv Radiol"},{"issue":"04","key":"ref12","doi-asserted-by":"crossref","first-page":"524","DOI":"10.1016\/j.jvir.2015.12.753","article-title":"Endovascular thrombolysis in the management of iliofemoral thrombosis in children: a multi-institutional experience","volume":"27","author":"M Gaballah","year":"2016","journal-title":"J Vasc Interv Radiol"},{"key":"ref13","doi-asserted-by":"crossref","first-page":"S23","DOI":"10.1016\/j.jvir.2018.12.085","article-title":"03:18 PM Abstract No. 45 Prospective comparison of pharmacomechanical thrombolysis versus anticoagulation for treatment of pediatric iliofemoral deep venous thrombosis: 2-year follow up","volume":"30","author":"A Annam","year":"2019","journal-title":"J Vasc Interv Radiol"},{"issue":"08","key":"ref14","doi-asserted-by":"crossref","first-page":"1158","DOI":"10.1016\/j.jvir.2014.04.003","article-title":"Endovascular venous thrombolysis in children younger than 24 months","volume":"25","author":"K U Kukreja","year":"2014","journal-title":"J Vasc Interv Radiol"},{"issue":"09","key":"ref15","doi-asserted-by":"crossref","first-page":"1540","DOI":"10.1007\/s00247-024-05985-7","article-title":"Selective iliofemoral stent placement for complex pediatric cases: a decade of institutional experience","volume":"54","author":"S Karim","year":"2024","journal-title":"Pediatr Radiol"},{"issue":"03","key":"ref16","doi-asserted-by":"crossref","first-page":"e189","DOI":"10.1055\/s-0040-1714694","article-title":"Clinical outcomes of May-Thurner syndrome in pediatric patients: a single institutional experience","volume":"4","author":"D M Warad","year":"2020","journal-title":"TH Open"},{"issue":"02","key":"ref18","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1001\/jama.2021.23182","article-title":"Effect of anticoagulant therapy for 6 weeks vs 3 months on recurrence and bleeding events in patients younger than 21 years of age with provoked venous thromboembolism: the kids-DOTT randomized clinical trial","volume":"327","author":"N A Goldenberg","year":"2022","journal-title":"JAMA"},{"issue":"09","key":"ref19","doi-asserted-by":"crossref","first-page":"1209","DOI":"10.1007\/s00247-017-3933-7","article-title":"Lower-extremity venous ultrasound - past, present and future","volume":"47","author":"R Goldfisher","year":"2017","journal-title":"Pediatr Radiol"},{"issue":"01","key":"ref21","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1097\/HPC.0b013e3181d29713","article-title":"The use and limitations of unfractionated heparin","volume":"9","author":"A Krishnaswamy","year":"2010","journal-title":"Crit Pathw Cardiol"},{"issue":"06","key":"ref22","first-page":"408","article-title":"Bivalirudin as an alternative to heparin for anticoagulation in infants and children","volume":"20","author":"M L Buck","year":"2015","journal-title":"J Pediatr Pharmacol Ther"},{"issue":"06","key":"ref23","doi-asserted-by":"crossref","first-page":"1580","DOI":"10.1148\/rg.220019","article-title":"Update on pediatric interventional radiology","volume":"42","author":"V A Young","year":"2022","journal-title":"Radiographics"},{"issue":"04","key":"ref24","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1111\/j.1527-3466.2005.tb00177.x","article-title":"Bivalirudin: pharmacology and clinical applications","volume":"23","author":"N W Shammas","year":"2005","journal-title":"Cardiovasc Drug Rev"},{"issue":"09","key":"ref25","doi-asserted-by":"crossref","first-page":"2126","DOI":"10.1111\/jth.14935","article-title":"Use of direct oral anticoagulants in patients with thrombotic antiphospholipid syndrome: guidance from the Scientific and Standardization Committee of the International Society on Thrombosis and Haemostasis","volume":"18","author":"S Zuily","year":"2020","journal-title":"J Thromb Haemost"},{"issue":"02","key":"ref26","doi-asserted-by":"crossref","first-page":"100957","DOI":"10.1016\/j.tvir.2024.100957","article-title":"Interventional treatment of pediatric venous thromboembolic disease","volume":"27","author":"E Herzog","year":"2024","journal-title":"Tech Vasc Interv Radiol"},{"issue":"01","key":"ref27","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1182\/blood-2004-11-4211","article-title":"How I treat venous thrombosis in children","volume":"107","author":"M J Manco-Johnson","year":"2006","journal-title":"Blood"},{"issue":"03","key":"ref28","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1111\/ijlh.12219","article-title":"Laboratory testing issues for protein C, protein S, and antithrombin","volume":"36","author":"R A Marlar","year":"2014","journal-title":"Int J Lab Hematol"},{"issue":"06","key":"ref29","doi-asserted-by":"crossref","first-page":"1104","DOI":"10.1016\/j.jvsv.2020.05.006","article-title":"A review into the management of May-Thurner syndrome in adolescents","volume":"8","author":"V Hansrani","year":"2020","journal-title":"J Vasc Surg Venous Lymphat Disord"},{"issue":"03","key":"ref30","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1111\/j.1538-7836.2011.04594.x","article-title":"Definition of post-thrombotic syndrome following lower extremity deep venous thrombosis and standardization of outcome measurement in pediatric clinical investigations","volume":"10","author":"N A Goldenberg","year":"2012","journal-title":"J Thromb Haemost"},{"issue":"11","key":"ref31","doi-asserted-by":"crossref","first-page":"1952","DOI":"10.3324\/haematol.2010.026989","article-title":"Post-thrombotic syndrome in children: a systematic review of frequency of occurrence, validity of outcome measures, and prognostic factors","volume":"95","author":"N A Goldenberg","year":"2010","journal-title":"Haematologica"},{"issue":"19","key":"ref32","first-page":"3737","article-title":"Characteristics of upper- and lower-extremity deep vein thrombosis and predictors of postthrombotic syndrome in children","volume":"5","author":"L Avila","year":"2021","journal-title":"Blood Adv"},{"key":"ref33","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1016\/j.thromres.2017.07.024","article-title":"Post-thrombotic syndrome in children","volume":"164","author":"M Betensky","year":"2018","journal-title":"Thromb Res"},{"issue":"02","key":"ref34","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1038\/ncpneph1019","article-title":"Acute kidney injury caused by intravascular hemolysis after mechanical thrombectomy","volume":"5","author":"R Dukkipati","year":"2009","journal-title":"Nat Clin Pract Nephrol"},{"issue":"07","key":"ref35","doi-asserted-by":"crossref","first-page":"721","DOI":"10.1016\/j.crad.2013.01.001","article-title":"Inferior vena cava filters: what radiologists need to know","volume":"68","author":"J J Harvey","year":"2013","journal-title":"Clin Radiol"},{"issue":"12","key":"ref36","doi-asserted-by":"crossref","first-page":"1595","DOI":"10.1007\/s00270-024-03898-4","article-title":"Early thrombus removal for acute lower extremity deep vein thrombosis: update on inclusion, technical aspects, and postprocedural management","volume":"47","author":"A N Plotnik","year":"2024","journal-title":"Cardiovasc Intervent Radiol"},{"issue":"18","key":"ref37","doi-asserted-by":"crossref","first-page":"2091","DOI":"10.1182\/blood-2015-06-651661","article-title":"Monitoring unfractionated heparin in children: a parallel-cohort randomized controlled trial comparing 2 dose protocols","volume":"126","author":"A Hanslik","year":"2015","journal-title":"Blood"},{"issue":"06","key":"ref38","doi-asserted-by":"crossref","first-page":"605","DOI":"10.1097\/MBC.0000000000000469","article-title":"How to use unfractionated heparin to treat neonatal thrombosis in clinical practice","volume":"27","author":"M D Bhatt","year":"2016","journal-title":"Blood Coagul Fibrinolysis"},{"issue":"03","key":"ref39","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1053\/j.tvir.2010.03.004","article-title":"Radiation safety in pediatric interventional radiology","volume":"13","author":"M Sidhu","year":"2010","journal-title":"Tech Vasc Interv Radiol"},{"key":"ref40","doi-asserted-by":"crossref","first-page":"5789","DOI":"10.1118\/1.4747450","article-title":"Radiation dose management for fluoroscopically guided interventional medical procedures","volume":"39","author":"M Mahesh","year":"2012","journal-title":"Med Phys"},{"issue":"03","key":"ref41","doi-asserted-by":"crossref","first-page":"e13526","DOI":"10.1002\/acm2.13526","article-title":"AAPM medical physics practice guideline 12.a: fluoroscopy dose management","volume":"23","author":"R F Fisher","year":"2022","journal-title":"J Appl Clin Med Phys"},{"issue":"04","key":"ref43","doi-asserted-by":"crossref","first-page":"755","DOI":"10.2214\/AJR.18.20508","article-title":"Patient shielding in diagnostic imaging: discontinuing a legacy practice","volume":"212","author":"R M Marsh","year":"2019","journal-title":"AJR Am J Roentgenol"},{"issue":"02","key":"ref44","doi-asserted-by":"crossref","first-page":"326","DOI":"10.1148\/radiol.2542082312","article-title":"Fluoroscopically guided interventional procedures: a review of radiation effects on patients' skin and hair","volume":"254","author":"S Balter","year":"2010","journal-title":"Radiology"},{"issue":"01","key":"ref45","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1055\/s-0032-1302450","article-title":"Deep vein thrombosis: thrombolysis in the pediatric population","volume":"29","author":"L A Greene","year":"2012","journal-title":"Semin Intervent Radiol"},{"issue":"13","key":"ref50","doi-asserted-by":"crossref","first-page":"2692","DOI":"10.1007\/s00247-023-05785-5","article-title":"Percutaneous treatment of symptomatic deep vein thrombosis in adolescents using large-bore thrombectomy systems","volume":"53","author":"E J Monroe","year":"2023","journal-title":"Pediatr Radiol"},{"issue":"02","key":"ref53","doi-asserted-by":"crossref","first-page":"175","DOI":"10.2214\/AJR.22.27413","article-title":"Antithrombotic therapy after venous interventions: AJR expert panel narrative review","volume":"219","author":"S Kishore","year":"2022","journal-title":"AJR Am J Roentgenol"},{"issue":"02","key":"ref54","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1177\/02683555241276565","article-title":"Efficacy of ultrasound in the evaluation of iliac vein stenting","volume":"40","author":"H Clode","year":"2025","journal-title":"Phlebology"}],"container-title":["Seminars in Interventional Radiology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0045-1811718.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:31:24Z","timestamp":1760135484000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/s-0045-1811718"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6]]},"references-count":45,"journal-issue":{"issue":"03","published-online":{"date-parts":[[2025,10,10]]},"published-print":{"date-parts":[[2025,6]]}},"URL":"https:\/\/doi.org\/10.1055\/s-0045-1811718","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0739-9529","1098-8963"],"issn-type":[{"value":"0739-9529","type":"print"},{"value":"1098-8963","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6]]}}}