Minimally invasive procedure for removal of infected ventriculoatrial shunts

Abstract

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.

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

“…Endovascular retrieval of VA shunt catheters in the heart was reported as early as the 1970s. [11][12][13][14] Various tools and techniques are available for retrieval, including loop-snare devices, forceps, hooked catheters, and balloon catheters. 15 Most case reports describe use of a snare, which can be introduced through the internal jugular or femoral vein.…”

“…15 Most case reports describe use of a snare, which can be introduced through the internal jugular or femoral vein. 3,13,16 Endovascular techniques have also been used to reposition distal VA shunt catheters that are in suboptimal positions. 17,18 In this patient, a broken distal shunt catheter was safely removed using an endovascular technique before proceeding to surgery for replacement of the distal catheter.…”

A Novel Non-Invasive Intervention for Removing Occlusions From Shunts Using an Abrading Magnetic Microswarm

“…However, inserting a tip wire in the shunt is required in this approach, which is considered invasive [14] A thoracotomy is another technique for cleaning a shunt, especially when a blood clot blocks the shunt. However, the A novel non-invasive intervention for removing occlusions from shunts using an abrading magnetic microswarm A. Moghanizadeh + , H. Khaksar + , and A. K. Hoshiar*, Member, IEEE A 2 thoracotomy might cause infection at the catheter entry site [15]. Using short pulses of infrared light generated by a Holmium: YAG (Ho: YAG) surgical laser to photofragment the clot has also been investigated as a method to remove the occlusions and restore flow in ventricular shunts.…”