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Occurrence and management of fractured peripheral catheters in CSF shunts
I A Langmoen1, T Lundar, K Vatne
1Department of Neurosurgery, National Hospital, University of Oslo, Norway.
Insights
Cerebrospinal fluid shunt fractures occurred in 60 pediatric cases, primarily in Pudenz catheters. Percutaneous transvascular snare removal was successful in 24 of 27 attempts for fractured drains.
Area of Science:
- Pediatric Neurosurgery
- Medical Device Failure Analysis
- Vascular Surgery
Background:
- Cerebrospinal fluid (CSF) shunts are critical for managing hydrocephalus in children.
- Shunt malfunction, particularly peripheral drain fracture, is a significant cause of treatment failure.
- Understanding fracture patterns and locations is essential for improving shunt design and patient outcomes.
Purpose of the Study:
- To analyze the incidence, location, and characteristics of peripheral drain fractures in pediatric CSF shunts.
- To identify the types of shunts and catheters most susceptible to fracture.
- To evaluate the efficacy of percutaneous transvascular snare removal for fractured drains.
Main Methods:
- Retrospective review of 2065 CSF shunt procedures in 716 children.
- Analysis of shunt failure reports specifically for peripheral drain fractures.
- Documentation of fracture location, catheter type, and fragmentation patterns.
- Assessment of percutaneous transvascular snare removal success rates.
Main Results:
- Sixty peripheral drain fractures were identified across 2065 procedures (2.9%).
- Fractures occurred in 38 ventriculo-atrial and 22 ventriculo-peritoneal shunts, predominantly in Pudenz catheters (59/60).
- Common fracture sites were 2-4 cm above the neck incision (cardiac) and just cephalad to the clavicle (abdominal).
- Fractured atrial catheter fragments were found in situ or dislodged into the right cardiac ventricle, pulmonary arteries, right atrium, or hepatic veins.
- Percutaneous transvascular snare removal was successful in 24 out of 27 attempted cases.
Conclusions:
- Peripheral drain fracture is a notable complication of pediatric CSF shunts, particularly with Pudenz catheters.
- Specific anatomical locations predispose drains to fracture, necessitating careful surgical placement and monitoring.
- Percutaneous transvascular snare removal offers a highly effective minimally invasive option for managing fractured shunt drains.
Abstract:
A series of 716 children underwent 2065 cerebrospinal fluid shunt procedures. Shunt failure due to fracture of the peripheral drain occurred 60 times, 38 times in ventriculo-atrial and 22 times in ventriculo-peritoneal shunts. The break occurred most commonly 2-4 cm above the neck incision in cardiac and just cephalad to the clavicle in abdominal drains. Fifty-nine ruptures occurred in Pudenz catheters (which were used in 82% of the shunts) and 1 occurred in a Holter drain (used in 17%). The fractured atrial catheters remained in situ (5/38) or were dislodged into the right cardiac ventricle (14/38), pulmonary arteries (9/38), right atrium (5/38) or hepatic veins (3/38). Two of the ruptured drains could not be located. Removal by a percutaneous transvascular snare technique was attempted in 27 cases and was successful in 24.