Intracardial Catheter Migration of a Ventriculoperitoneal Shunt: Pathophysiology and Interdisciplinary Management

Adib, Sasan Darius; Lescan, Mario; Renovanz, Mirjam; Schuhmann, Martín U.; Trakolis, Leonidas; Bongers, Malte; Tatagiba, Marcos; Döbele, Alexander; Grözinger, Gerd

doi:10.1016/j.wneu.2019.12.089

Cited by 10 publications

(22 citation statements)

References 37 publications

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“…Distal catheter migration of VP shunts most commonly arises from peritoneal perforation and has been observed in a variety of organ systems such as lumbar soft tissue penetration following discectomy, bladder perforation and extrusion through the urethral orifice, ascension into the oropharyngeal cavity through the gastrointestinal tract, and descension into the scrotum through a congenital remnant [8][9][10][11]. Spontaneous intracardiac migration, such as the basis of this case report, has been documented previously in the literature, albeit rarely [12][13][14][15][16][17].…”

Section: Discussionmentioning

confidence: 83%

“…Two main theories have dominated the literature. One is that cannulation of the venous system occurs during distal tunneling of the shunt catheter that goes unnoticed intraoperatively [12,13]. The second is that the catheter, over time with repeated friction contact, erodes into an adjacent vein.…”

Section: Discussionmentioning

confidence: 99%

“…The second is that the catheter, over time with repeated friction contact, erodes into an adjacent vein. This mechanism has historically been attributed to stiffness of the catheter [12]. The association between reduced occurrence of migration and softer, more flexible catheters suggests that a mechanical component exists in shunt migration [14].…”

Section: Discussionmentioning

confidence: 99%

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Spontaneous Migration of a Ventriculoperitoneal Shunt into the Venous System: A Multidisciplinary Approach

Nardone

Marotta

Smith

et al. 2020

Cureus

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Section: Discussionmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Spontaneous Migration of a Ventriculoperitoneal Shunt into the Venous System: A Multidisciplinary Approach

Nardone

Marotta

Smith

et al. 2020

Cureus

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“…We found 28 cases. [ 1 ] Furthermore, In our research of thoracic pseudocyst due to VP shunt. We found many cases but all are in abdominal spaces.…”

Section: Discussionmentioning

confidence: 96%

Thoracic abscess due to unusual migration of a ventriculoperitoneal shunt and literature review

Sayore

Hemama

Adjiou

et al. 2021

Surgical Neurology International

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Background: Thoracic complications of ventriculoperitoneal (VP) cerebrospinal fluid shunting are rare and the diagnosis is difficult without neurological impairment. Case Description: We report a case of a 36-year-old woman who had a VP shunt in the right side when she was 13 years for a posterior fossa ependymoma and hydrocephalus. 23 years after surgery, she developed acute yellowfish cough and sputum, and the computed tomography scan found an intrathoracic cyst. She had a thoracotomy for the cyst and during surgery, we found the peritoneal catheter of the VP shunt, with a collected abscess in the left side. The patient was treated for the abscess and the VP shunt was removed. We also review the literature cases of thoracic complications after VP shunts. Conclusion: Thoracic abscess due to VP shunt migration is extremely rare and could happen after a long time delay VP shunt surgery.

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“…To the best of our knowledge, only 24 cases with SCMPA have been previously reported [Table 1]. [3,5,8,9,13,[22][23][24][25]27,32,39] We present the first case of an asymptomatic pediatric patient with SCMPA, further complicated by extensive knotting and indolent arterial thrombosis. is complication necessitated removal of the retained catheter through open-heart surgery, given our inability to retract the system after repeated manipulation using less invasive techniques.…”

Section: Introductionmentioning

confidence: 99%

Delayed peritoneal shunt catheter migration into the pulmonary artery with indolent thrombosis: A case report and narrative review

Patel

Zhang

Khan

et al. 2022

Surgical Neurology International

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Background: Ventriculoperitoneal (VP) shunts are the preferred surgical treatment for hydrocephalus, and rarely, these operations may be complicated by catheter migration to ectopic sites. We present the case of an asymptomatic VP shunt patient with delayed peritoneal catheter migration into the pulmonary artery shunt catheter migration into the pulmonary artery (SCMPA) complicated by knotting and indolent thrombosis, necessitating open-heart surgery for system retrieval. Methods: We conducted a literature review in PubMed, Scopus, and Web of Science of prior similar reported cases and present the results of 24 cases of SCMPA. Results: An asymptomatic 12-year-old male presented with SCMPA noted on routine annual follow-up imaging. Preoperative CT angiogram indicated extensive catheter looping into the pulmonary artery without evidence of thrombosis. Less invasive attempts to retrieve the retained catheter were unsuccessful, and open-heart surgery was required. Intraoperatively, a nonocclusive pulmonary arterial thrombus surrounding the knotted catheter was discovered that was lysed successfully before system retrieval. Conclusion: VP shunt catheter migration into the pulmonary artery (SCMPA) with concurrent large vessel thrombosis can develop in pediatric patients incidentally without any clinical symptoms. Our report suggests that preoperative CT angiogram may be insufficient to detect arterial thrombosis in the presence of extensive intravascular catheter knotting. An open-chest approach may be the only viable surgical option for catheter retrieval in the presence of complex catheter coiling. The use of anticoagulation following open-heart surgery for retrieval of a migrated VP shunt catheter remains unclear, we here propose that continuation of long-term therapeutic anticoagulation may successfully prevent thrombus relapse.

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Intracardial Catheter Migration of a Ventriculoperitoneal Shunt: Pathophysiology and Interdisciplinary Management

Cited by 10 publications

References 37 publications

Spontaneous Migration of a Ventriculoperitoneal Shunt into the Venous System: A Multidisciplinary Approach

Spontaneous Migration of a Ventriculoperitoneal Shunt into the Venous System: A Multidisciplinary Approach

Thoracic abscess due to unusual migration of a ventriculoperitoneal shunt and literature review

Delayed peritoneal shunt catheter migration into the pulmonary artery with indolent thrombosis: A case report and narrative review

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