title: The role of a vascular access surgeon in ventriculo-venous shunts in difficult hydrocephalus.
abstract: BACKGROUND
  Cerebrospinal fluid (CSF) diversion into the right atrium or peritoneal cavity is the mainstay of treatment for normotensive hydrocephalus. Unfortunately multiple shunt failures can lead to patients returning for repeat interventions, leaving drainage options limited. We present a case series of five patients requiring venous access for shunt placement.
  
  
  METHODS
  Using the St Georges technique of axillary vein dissection, a suitable vein draining into the axillary vein was found and a shunt inserted under direct vision into the vein.
  
  
  RESULTS
  Four females and one male were retrospectively followed up from first venous shunt employment in February 2003 to May 2008. Of the 34 revised shunts performed (ventriculo-peritoneal, ventriculo-pleural or ventriculo-venous) in the group, 13 procedures included the use of the axillary vein for CSF diversion. All shunts had a cumulative primary and secondary patency of 50% and 80% at 1 yr, respectively. There was no significant difference in the primary or secondary patency between the three types.
  
  
  CONCLUSIONS
  We have presented a series of 35 primary and secondary shunts in five patients with hydrocephalus. All patients had exhausted all CSF diversion options prior to the use of the axillary vein. With comparable survival of the axillary shunts with ventriculo-pleural and peritoneal shunts, we therefore present a favorable outcome in the use of the axillary vein for CSF diversion.
authors.affiliation: Department of Renal and Vascular Access Surgery, St Georges Hospital NHS Trust, London, UK.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Ayaz Hossain
authors.forename: Adam Enver
authors.initials: AE
authors.lastname: Frampton
authors.forename: Melissa
authors.initials: M
authors.lastname: Choo
authors.forename: Mohamed
authors.initials: M
authors.lastname: Morsy
authors.forename: Henry Thomas
authors.initials: HT
authors.lastname: Marsh
authors.forename: Andrew James
authors.initials: AJ
authors.lastname: Martin
authors.forename: Eric Solomon
authors.initials: ES
authors.lastname: Chemla
mesh_terms: D000328:Adult; D001367:Axillary Vein / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D002557:Cerebrospinal Fluid Shunts / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000134:cerebrospinal fluid / Q000601:surgery*; D053208:Kaplan-Meier Estimate; D008131:London; D008297:Male; D010690:Phlebography / Q000379:methods; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014654:Vascular Patency; D014656:Vascular Surgical Procedures / Q000009:adverse effects; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects; D055815:Young Adult