Endovascular placement of a ventriculoatrial shunt. Technical note.

Atrial shunt revision surgeries are sometimes difficult due to venous occlusion and neck scarring. A direct approach guided by venography facilitates exposure and guarantees accurate placement of the distal catheter. Five patients with complicated histories of shunt malfunction were treated using an endoscope-assisted technique. The distal end of an atrial catheter was advanced into the atrium after having been connected to a venous catheter of a slightly smaller diameter than the one previously advanced from the femoral vein through the atrium. Once the position of the atrial catheter was confirmed fluoroscopically, the venous catheter was detached and removed. No complications developed in any patient. This endoscope-assisted technique offers three advantages: it demonstrates the patency of the jugular vein through venography, facilitates identification of the internal jugular vein in the neck, and provides a quick way to confirm that the distal end of the atrial catheter has been placed correctly. This technique should be considered for use in patients with a history of failed atrial shunts.