Venous Thrombosis as a Complication of Ventriculoatrial Shunt – a Case Report

Czech version

Authors: L. Jurák ¹; P. Buchvald ¹; V. Beneš lll ¹; D. Oršulík ²; P. Suchomel ¹
Authors‘ workplace: Krajská nemocnice Liberec, a. s. Neurochirurgické oddělení ¹; Krajská nemocnice Liberec, a. s. Radiologické oddělení ²
Published in: Cesk Slov Neurol N 2015; 78/111(4): 477-481
Category: Case Report

Overview

Thromboembolic disease is one of possible complications of ventriculoatrial shunt. Our case report describes a 20-year-old patient who was prenatally diagnosed with obstructive hydrocephalus and was postnatally treated with a ventriculoperitoneal shunt and, subsequently, because of cerebrospinal fluid malabsorption in the peritoneal cavity, with ventriculoatrial shunt. Two years after the surgery, the patient was admitted with recurrent symptoms of dyspnoea, morning oedema of the face and neck and two-day history of vertigo with feeling of pressure inside her head. Venous ultrasonography revealed thrombus in the left internal jugular vein and around the atrial end of the shunt. Anticoagulation therapy using subcutaneous application of low-molecular-weight heparin enoxaparin was started. Ventriculoatrial shunt was removed and replaced with ventriculoperitoneal shunt. Eventually, three of four closed veins were recanalized. After one year of thrombosis treatment, the patient is without any significant subjective or objective problems and she is treated with warfarin.

Key words:
thromboembolic disease – venous thrombosis – ventriculoatrial shunt – hydrocephalus – anticoagulation therapy

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.

Sources

1. Nulsen FE, Spitz EB. Treatment of hydrocephalus by direct shunt from ventricle to jugular vein. Surg Forum 1951: 399– 403.

2. Pudenz RH, Russell FE, Hurd AH, Shelden CH. Ventriculo‑ auriculostomy; a technique for shunting cerebrospinal fluid into the right auricle; preliminary report. J Neurosurg 1957; 14(2): 171– 179.

3. Drucker MH, Vanek VW, Franco AA, Hanson M, Woods L.Thromboembolic complications of ventriculoatrial shunts. Surg Neurol 1984; 22(5): 444– 448.

4. Lipina R, Paleček T. Chirurgické řešení hydrocefalu v dětském věku. Pediatr Prax 2004; 3: 133– 136.

5. Vybíhal V. Chirurgická léčba hydrocefalu. Cesk Slov Neurol N 2014; 77/ 110(1): 7– 22.

6. Tsingoglou S, Forrest DM. Complications from Holter ventriculo‑ atrial shunts. Br J Surg 1971; 58(5): 372– 377.

7. Wilkinson N, Sood S, Ham SD, Gilmer‑ Hill H, Fleming P, Rajpurkar M. Thrombosis associated with ventriculoatrial shunts. J Neurosurg Pediatr 2008; 2(4): 286– 291. doi: 10.3171/ PED.2008.2.10.286.

8. Favara BE, Paul RN. Thromboembolism and cor pulmonale complicating ventriculovenous shunt. JAMA 1967; 199(9): 668– 671.

9. Ladouceur D, Giroux M. Echocardiographic detection of intracardiac thrombi complicating ventriculo‑ atrial shunt. Report of two cases. Pediatr Neurosurg 1994; 20(1): 68– 72.

10. Wells CA, Senior AJ. Coronary sinus thrombosis and myocardial infarction secondary to ventriculoatrial shunt insertion. J Pediatr Surg 1990; 25(12): 1214– 1215.

11. Parizek J, Nytra T, Zemankova M, Eliás P, Sercl M, Nĕmecková J et al. Catheterobronchial fistula due to vena cava superior thrombosis as a late complication of ventriculoatrial shunt. Childs Nerv Syst 1994; 10(7): 468– 471.

12. Tonn P, Gilsbach JM, Kreitschmann‑Andermahr I, Franke A, Blindt R. A rare but life‑ threatening complication of ventriculo‑ atrial shunt. Acta Neurochir (Wien) 2005; 147(12): 1303– 1304.

13. Yurtseven T, Ersahin Y, Kitis O, Mutluer S. Thrombosis and thrombophilebitis of the internal jugular vein as a very rare complication of the ventriculoatrial shunt. Clin Neurol Neurosurg 2005; 107(2): 144– 146.

14. Monagle P, Chan A, Massicotte P, Chalmers E, Michelson AD. Antithrombotic therapy in children: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 2004; 126 (Suppl 3): 645S– 687S.

15. Starkey IR, de Bono DP. Echocardiographic identification of right‑ sided cardiac intracavitary thromboembolus in massive pulmonary embolism. Circulation 1982; 66(6): 1322– 1325.

16. Konstantinides S, Geibel A, Olschewski M, Heinrich F, Grosser K, Rauber K et al. Association between thrombolytic treatment and the prognosis of hemodynamically stable patients with major pulmonary embolism: results of a multicenter registry. Circulation 1997; 96(3): 882– 888.

17. Dudiy Y, Kronzon I, Cohen HA, Ruiz CE. Vacuum thrombectomy of large right atrial thrombus. Catheter Cardiovasc Interv 2012; 79(2): 344– 347. doi: 10.1002/ ccd.23190.

18. Mukharji J, Peterson JE. Percutaneous removal of a large mobile right atrial thrombus using a basket retrieval device. Catheter Cardiovasc Interv 2000; 51(4): 479– 482.

19. Milton CA, Sanders P, Steele PM. Late cardiopulmonary complication of ventriculo‑ atrial shunt. Lancet 2001; 358(9293): 1608.