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

Abstract

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.

A Rare Case of Delayed Ventriculoperitoneal Shunt Catheter Migration Into the Heart: A Case Report

“…Also, cardiac migration of VP shunt catheters mainly occurs in pediatric patients or individuals aged 60 and above. 14 15) In pediatric cases, it is assumed that the thin subcutaneous tissue in the neck makes jugular vein injury more likely. Conversely, in individuals aged 60 and above, the looser subcutaneous tissue may lead to more frequent vein injuries during procedures.…”

“…Also, if vegetation has formed on the shunt catheter, there is also an embolic risk. Patel et al 14) reported that open heart surgery was performed to remove a knotted catheter migrated to the heart. Therefore, considering the possible risks, shunt catheter removal should be carefully performed in consultation with a cardiologist.…”

What Is the Best Surgical Intervention for Patients With Idiopathic Intracranial Hypertension?

“…These risks of venous stenting should be explained to every patient consenting for the procedure but should be placed in context of the myriad risks that are inherent in CSF shunting. These include central nervous system infection and acute or delayed intraparenchymal hemorrhage, all of which can be fatal, 48,49 as well as ectopic migration of the peritoneal tip to sites as disparate as the pulmonary artery (often with secondary thrombosis), 50 mouth, 51 urethra, 52 or rectum. 53 In one single-center series of 95 patients treated with VPS over an 8-year period, 54 there were 5 severe complications, and one fatal, yielding a mortality rate of approximately 1%.…”