839 Techniques for Management and Avoidance of Ventriculo Artrial Shunt Distal Catheter Complications

Abstract

INTRODUCTION: Minimizing the risk of distal ventriculatrial (VA) shunt disconnection is particularly important due to the risk of catheter embolization. This rare event occurs in approximately 1.56% of implanted VA shunts. There are no clear treatment guidelines in the literature to help prevent and manage this complication. The use of a connector in the neck has been implicated in mechanical failures of ventriculoperitoneal (VP) shunts;2however, to the best of our knowledge, there was no literature describing disconnection and migration of distal VA shunt catheters due to use of a connector. METHODS: Clinical records for a single institution between 2010 and 2021 were reviewed for instances of distal catheter disconnection and migration. RESULTS: All three instances of distal disconnection were associated with use of a connector in the neck that resulted in fracture of the catheter due to repetitive sheering forces. In all three cases, the distal catheter was retrieved via an endovascular approach in conjunction with transesophageal echocardiography to assess for retrieval feasibility. An additional case is included where the distal catheter is abandoned due to adhesions and the patient was placed on anticoagulation. CONCLUSIONS: We recommend the avoidance of a straight connector when performing VA shunt placement. Catheter removal requires a multidisciplinary approach to best reduce risk of complications.