title: Ultrasound guidance for distal insertion of ventriculo-atrial shunt catheters: technical note.
abstract: Ventriculo-atrial (VA) shunts are often used for CSF diversion in situations involving abdominal pathology that preclude the use of ventriculo-peritoneal shunts. Distal (venous) catheters of VA shunts have historically been inserted using a cut-down on the internal jugular vein (IJV). Less invasive placement of atrial catheters may minimize operative times and attenuate post-operative incisional discomfort. We describe a method for atrial catheter placement using ultrasound guidance to visualize the IJV and facilitate percutaneous venous puncture in 17 adult patients (23 total insertions) undergoing treatment for hydrocephalus or pseudotumor cerebri. The IJV and carotid artery were visualized by ultrasound in 23 (100%) cases. Venous penetration and successful atrial catheter placement was achieved on the first attempt in 23 (100%) cases. Pneumothorax, carotid artery puncture or need for venous cut-down occurred in no cases. The utilization of ultrasound guidance for distal VA shunt catheter insertion may increase comfort with this procedure and ultimately decrease complication rate and operative time.
authors.affiliation: David Geffen School of Medicine at the University of California, Los Angeles Los Angeles, CA 90024, USA.
authors.forename: Sameer A
authors.initials: SA
authors.lastname: Sheth
authors.forename: Matthew
authors.initials: M
authors.lastname: McGirt
authors.forename: Graeme
authors.initials: G
authors.lastname: Woodworth
authors.forename: Paul
authors.initials: P
authors.lastname: Wang
authors.forename: Daniele
authors.initials: D
authors.lastname: Rigamonti
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002339:Carotid Arteries / Q000000981:diagnostic imaging; D002408:Catheters, Indwelling / Q000009:adverse effects; D002557:Cerebrospinal Fluid Shunts / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D006325:Heart Atria; D006801:Humans; D006849:Hydrocephalus / Q000000981:diagnostic imaging / Q000628:therapy; D007601:Jugular Veins / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D011559:Pseudotumor Cerebri / Q000000981:diagnostic imaging / Q000628:therapy; D018608:Ultrasonography, Doppler / Q000379:methods*