Superior vena cava syndrome with retropharyngeal edema as a complication of ventriculoatrial shunt

Abstract

Key Clinical MessageThirty-seven-year old female with hydrocephalus managed by a ventriculoatrial (VA) shunt presented with upper body edema, dysphagia, and headache. Imaging demonstrated thrombosis of the superior vena cava (SVC). Direct catheter thrombolysis led to resolution of thrombus burden. Superior vena cava thrombosis is a rare consequence of VA shunting and must be managed emergently.

Anesthetic considerations for ventriculoatrial shunt insertion in a child with cerebrospinal fluid ascites

“…[ 5 ] Superior vena caval thrombosis is a rare complication of VA shunt procedure. [ 6 ] Hence, long-term follow-up is necessary of such patients.…”

Thrombosis associated with ventriculoatrial shunts

“…When the tip of the catheter moves out of the atrium and into the great vessels, increasing the risk of thrombosis [38]. Other thromboembolic risk factors include SVC stenosis, current smoking, oral contraceptive, obesity, parenteral nutrition, and malignancy [21,[39][40][41][42]. Distal tip thrombsis may occur more commonly in patients with these factors because the blood is in hypercoagulative state.…”

“…When obstruction develops slowly and progressively, a collateral circulation develops and symptoms are mild or absent. However, rapid obstruction can lead to significant edema and color changes on the upper extremity, neck, and face, with or without dysphagia, pain, and dyspnea [ 14 , 39 ]. If the thrombus is located in jugular vein and large enough, it may appear as a neck mass lesion, which may be the only clue of thrombosis [ 17 , 42 ].…”

“…In recent years, direct catheter thrombolysis followed by endovascular angioplasty and stenting are emerging modalities of treatment in cases of thrombosis and SVC stenosis secondary to intravenous catheters. These options appear to be very promising and safe alternatives to open surgical bypass [ 39 ].…”

“…It is important to note that a VAS may be unsuitable for those patients who are complicated by heart disease, respiratory disease, coagulation disturbance, hereditary hypercoagulability diseases, history of thrombosis, and scarring at the insertion site in the neck [ 74 ]. In addition, because of the high prevalence of PE and PH, indication of VAS has to be retained considering thromboembolic risk factors as SCV stenosis, current smoking, oral contraceptive, obesity, or intravenous alimentation [ 3 , 21 , 39 ].…”