Snare retrieval of migrated ventriculoatrial shunt

Endovascular retrieval of a broken distal ventriculoatrial shunt catheter within the heart: illustrative case

BACKGROUND

Displacement of a distal catheter of a ventriculoatrial (VA) shunt is a rare complication and can lead to a challenging extraction requiring endovascular retrieval of the distal catheter.

OBSERVATIONS

The authors describe a patient in whom the distal catheter of the VA shunt had become displaced and traveled through the tricuspid valve into the right ventricular outflow tract.

LESSONS

In this case report, the authors present a multidisciplinary approach to retrieving a displaced distal catheter from a VA shunt.

Minimally invasive procedure for removal of infected ventriculoatrial shunts

BACKGROUND

Ventriculoatrial shunts were one of the most common treatments of hydrocephalus in pediatric and adult patients up to about 40 years ago. Thereafter, due to the widespread recognition of the severe cardiac and renal complications associated with ventriculoatrial shunts, they are almost exclusively implanted when other techniques fail. However, late infection or atrial thrombi of previously implanted shunts require removal of the atrial catheter several decades after implantation. Techniques derived from management of central venous access catheters can avoid cardiothoracic surgery in such instances.

METHODS

We retrospectively investigated all the patients requiring removal of a VA shunt for complications treated in the last 5 years in our institution.

RESULTS

We identified two patients that were implanted 28 and 40 years earlier. Both developed endocarditis with a large atrial thrombus and were successfully treated endovascularly. The successful percutaneous removal was achieved by applying, for the first time in this setting, the endoluminal dilation technique as proposed by Hong. After ventriculoatrial shunt removal and its substitution with an external drainage, both patients where successfully weaned from the need for a shunt and their infection resolved.

CONCLUSION

Patients carrying a ventriculoatrial shunt are now rarely seen and awareness of long-term ventriculoatrial shunt complications is decreasing. However, these complications must be recognized and treated by shunt removal. Endovascular techniques are appropriate even in the presence of overt endocarditis, atrial thrombi, and tight adherence to the endocardial wall. Moreover, weaning from shunt dependence is possible even decades after shunting.

Combined cut down and endovascular retrieval of orphaned ventriculoatrial shunt with stenting of chronic superior vena cava occlusion

Revascularization of the superior vena cava (SVC) in the context of symptomatic luminal obstruction is a therapeutic intervention performed for SVC syndrome of benign or malignant etiology. Venous occlusion can preclude future access and cause symptoms ranging from mild chest discomfort to the more serious effects of SVC syndrome. This case report demonstrates the treatment of a novel case of SVC syndrome arising from a previously placed SVC stent. An intravascular, extraluminal orphaned ventriculoatrial shunt was used to go through the SVC but around the existing lumen-limiting stent to place a new larger stent for revascularization. This case highlights the need for an innovative approach for complex foreign body retrieval and treatment of chronic SVC occlusion.

Cross my heart: ventriculoatrial shunt migration into the pulmonary arteries

We present here a rare complication of ventriculoatrial shunt: migration of the distal catheter into both pulmonary arteries. The patient showed no cardiorespiratory symptoms. The catheter was removed by endovascular technic, the most usual procedure in these cases.

Distal Ventriculoatrial Shunt Revision in Adult Myelomeningocele Patient Performed via Endovascular Transvenous Approach

BACKGROUND

Myelomeningocele patients with shunt-dependent hydrocephalus often require multiple shunt revisions, eventually exhausting first-line distal diversion sites. Ventriculoatrial (VA) shunts are used less commonly than ventriculoperitoneal shunts, but knowledge of their use and complications is important to the neurosurgeon's armamentarium. VA shunts differ from ventriculoperitoneal and ventriculopleural shunts in that the ideal distal catheter target is an anatomically small area in comparison with the peritoneal and pleural cavities.

CASE DESCRIPTION

Here we present a case of an adult myelomeningocele patient who experienced migration of a distal VA shunt catheter. A minimally invasive revision technique that does not require recannulation of the vessels or open manipulation of the shunt is presented.

CONCLUSIONS

This is the fourth reported instance of successful distal revision of a migrated VA shunt catheter via transfemoral endovascular snaring. Knowledge of the opportunities afforded by this technique and collaboration with thoracic surgery colleagues is of benefit to all neurosurgeons.

Recurrent fever in patient in a minimally responsive state: An unusual origin of infection

Embolization of a severed tube of a ventriculo-atrial shunt into the heart is a rare but severe and potentially lethal complication of aresorptive hydrocephalus therapy in patients with severe neurological damage. A rare case is presented of a 53-year-old woman who suffered a severe subarachnoidal haemorrhage. After infection of the first shunting system, the patient underwent an exchange of the system, but repeatedly showed clinical and laboratory signs of infection which failed to improve despite several antibiotic treatments. This case illustrates that, although the patient was in poor neurological and medical condition, it is beneficial to remove the accidentally washed-in foreign body for two reasons. On the one hand to prevent avoidable life-threatening incidents, on the other hand to gain stable medical condition which will allow the patient to participate in neurorehabilitative treatment.

Upward migration of distal ventriculoperitoneal shunt catheter into the heart: case report

Ventriculoperitoneal (VP) shunt is commonly and effectively used to treat hydrocephalus. Intracardiac migration of the shunt catheter is a rare complication. A 68-year-old woman underwent ventriculoperitoneal shunting for hydrocephalus secondary to subarachnoid hemorrhage due to anterior communicating artery aneurysm rupture. Two weeks after the shunt surgery, she had suffered from the abdominal pain. Plain chest x-rays, computed tomography, and echocardiography revealed the distal catheter which was in the right ventricle of the heart. We tried to remove the catheter through the internal jugular vein by fluoroscopic guidance. But, the distal catheter was kinked and knotted; therefore, we failed to withdraw the catheter. After then, we punctured the right femoral vein and pulled down the multi-knotted shunt catheter to the femoral vein using the snare catheter. Finally, we removed the knotted distal catheter via the femoral vein and a new distal catheter was placed into the peritoneal cavity. We report a case in which the distal catheter of the VP shunt migrated into the heart via the internal jugular vein. We emphasize the importance of careful and proper placement of the distal catheter during the tunneling procedure to prevent life-threatening complications.