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Neurosurgical Review Apr 2022Ventriculoatrial shunts are the most common second-line procedure for cases in which ventriculoperitoneal shunts are unsuitable. Shunting-associated thrombosis is a... (Review)
Review
Ventriculoatrial shunts are the most common second-line procedure for cases in which ventriculoperitoneal shunts are unsuitable. Shunting-associated thrombosis is a potentially life-threatening complication after ventriculoatrial shunt insertion. The overall prevalence of this complication is still controversial because of substantial differences in the numbers found in studies using clinical data and in those analyzing postmortem findings. The etiology of thrombosis may be multifactorial, including shunt catheter itself, contents of cerebrospinal fluid, shunt infection, and genetic disorder. The clinical presentation can vary widely, ranging from asymptomatic to a life-threatening condition. Timely recognition of thromboembolic lesions is critical for treatment. However, early diagnosis and management is still challenging because of a relatively long asymptomatic latency and lack of clear guideline recommendations. The purpose of this review is to provide an overview of ventriculoatrial shunt thrombosis, especially to focus on its etiopathogenesis, diagnosis, treatment, and prevention.
Topics: Cerebrospinal Fluid Shunts; Humans; Hydrocephalus; Thromboembolism; Thrombosis; Ventriculoperitoneal Shunt
PubMed: 34647222
DOI: 10.1007/s10143-021-01656-5 -
Cardiology in the Young May 2023Systemic-to-pulmonary shunts are used as a source of pulmonary blood flow in palliated Congenital Heart Disease in neonates and young infants. Shunt thrombosis, often...
PURPOSE
Systemic-to-pulmonary shunts are used as a source of pulmonary blood flow in palliated Congenital Heart Disease in neonates and young infants. Shunt thrombosis, often requiring shunt interventions during index hospitalisation, is associated with poor outcomes. We hypothesised that extensive use of perioperative pro-coagulant products may be associated with shunt thrombosis.
METHODS
Children (≤18 years) undergoing systemic-to-pulmonary shunts with in-hospital shunt reinterventions between 2016 and 2020 were reviewed retrospectively. Perioperative associations to shunt thrombosis were examined by univariate logistic regression and Wilcoxon rank sum tests as appropriate. Cox and log transformed linear regression were used to analyse postoperative ventilation duration, length of stay, and cost.
RESULTS
Of 71 patients requiring in-hospital shunt intervention after systemic-to-pulmonary shunts, 10 (14%) had acute shunt thrombosis, and among them five (50%) died. The median age was four (interquartile range: 0-15) months. There were 40 (56%) males, 41 (58%) had single ventricle anatomy, and 29 (40%) were on preoperative anticoagulants. Patients with acute shunt thrombosis received greater volume of platelets (p = 0.04), cryoprecipitate (p = 0.02), and plasma (p = 0.04) postoperatively in the ICU; experienced more complications (p = 0.01) including re-exploration for bleeding (p = 0.008) and death (p = 0.02), had longer hospital length of stays (p = 0.004), greater frequency of other arterial/venous thrombosis (p = 0.02), and greater hospital costs (p = 0.002).
CONCLUSIONS
Patients who develop acute shunt thrombosis receive more blood products perioperatively and experience worse hospital outcomes and higher hospital costs. Future research on prevention/early detection of shunt thrombosis is needed to improve outcomes in infants after systemic-to-pulmonary shunt surgery.
Topics: Infant; Infant, Newborn; Male; Humans; Child; Female; Retrospective Studies; Treatment Outcome; Lung; Heart Defects, Congenital; Thrombosis
PubMed: 35638699
DOI: 10.1017/S1047951122001548 -
La Revue de Medecine Interne Jan 2024Splanchnic vein thrombosis includes Budd-Chiari syndrome and portal vein thrombosis. These diseases share common features: (i) they are rare diseases and (ii) they can... (Review)
Review
Splanchnic vein thrombosis includes Budd-Chiari syndrome and portal vein thrombosis. These diseases share common features: (i) they are rare diseases and (ii) they can lead to portal hypertension and its complications. Budd-Chiari syndrome and portal vein thrombosis in the absence of underlying liver disease share many risk factors, the most common being myeloproliferative neoplasms. A rapid and comprehensive workup for thrombosis risk factors is necessary in these patients. Long-term anticoagulation is indicated in most patients. Portal vein thrombosis can also develop in patients with cirrhosis, and is associated with a worse course of cirrhosis. Indications for anticoagulation in patients with cirrhosis are increasing. Transjugular intrahepatic portosystemic shunt is a second-line procedure in this setting. Because of the rarity of these diseases, high-level evidence studies are rare. However, collaborative studies have provided a better understanding of their natural history and allowed to improve the management of these patients. This review focuses on the causes, diagnosis, and management of patients with Budd-Chiari syndrome, patients with portal vein thrombosis without underlying liver disease, and patients with cirrhosis and portal vein thrombosis.
Topics: Humans; Budd-Chiari Syndrome; Portal Vein; Venous Thrombosis; Thrombosis; Portasystemic Shunt, Transjugular Intrahepatic; Liver Cirrhosis; Anticoagulants
PubMed: 37838484
DOI: 10.1016/j.revmed.2023.07.005 -
Wiadomosci Lekarskie (Warsaw, Poland :... 2023The aim: To analyze retrospectively our experience of Rex shunt in children with symptomatic portal hypertension, its effect on hypersplenism regression and varices...
OBJECTIVE
The aim: To analyze retrospectively our experience of Rex shunt in children with symptomatic portal hypertension, its effect on hypersplenism regression and varices eradication, assess shunt survival and investigate risk factors, that could lead to shunt dysfunction and thrombosis.
PATIENTS AND METHODS
Materials and methods: 24 children (16 males, 8 females) ,with portal hypertension included into the study. All surgeries were performed within single center in a period from January 2010 to March 2022. Follow up period was 6.75±1.19 years.
RESULTS
Results: Age at diagnosis was 5.39±0.64 years. 5 (20.8%) had umbilical catheter in anamnesis. 16 (66.7%) manifested bleeding episodes as the first sign of portal hypertension. 9 (37.5%) of children manifested severe hypersplenism. Age at Rex shunting was 7.5±0.7 years. In 7 (31.8%) cases Rex shunt thrombosis occurred. 1 successful thrombectomy and 6 splenorenal shunting were performed. Kaplan-Meyer analysis showed Rex shunt survival 0.670 (95%CI 0.420-0.831). Logistic regression model indicated thrombocytes count (p=0.0423) and cytopenia (p=0.0272) as factors that could influence shunt thrombosis. Follow-up group included 18 patients. Spleen volume regression became significant by 1 p/o year p<0,05, thrombocytes significant increasement reached in 1 p/o months (p<0.01), varices involution was achieved by 1 p/o year (p<0,001).
CONCLUSION
Conclusions: Rex shunt effectiveness in study group was 70.9%., shunt survival assessed 0.670 (95%CI 0.420-0.831). Rex shunt was effective in bleeding prophylaxis in all patients of follow up group. Preoperative thrombocytes count (p=0.0423) and cytopenia (p=0.0272) were detected as factors that could influence shunt thrombosis, that is to be considered in RS preoperative period and require following studies.
Topics: Child; Male; Female; Humans; Child, Preschool; Portasystemic Shunt, Surgical; Portal Vein; Retrospective Studies; Hypersplenism; Hypertension, Portal; Thrombosis; Varicose Veins
PubMed: 38290020
DOI: 10.36740/WLek202312105 -
Current Gastroenterology Reports Oct 2021Portal vein thrombosis (PVT) is a frequent consequence of cirrhosis and its management is variable and controversial. Herein we highlight interventional treatment... (Review)
Review
PURPOSE OF REVIEW
Portal vein thrombosis (PVT) is a frequent consequence of cirrhosis and its management is variable and controversial. Herein we highlight interventional treatment options and outcomes, together with mention of the physiology, presentation and imaging of PVT.
RECENT FINDINGS
Utilization of transjugular intrahepatic portosystemic shunt (TIPS) for acute and chronic PVT is expanding. In acute PVT, TIPS improves hepatopetal flow which promotes thrombus resorption and prevents rethrombosis. The TIPS also functions as a conduit for thrombectomy devices and allows for embolization of variceal shunts. Chronic PVT is a relative contraindication to liver transplant. Portal vein recanalization (PVR) TIPS restores flow in a previously occluded portal vein, allowing for a conventional end-to-end portal vein anastomosis at transplant. PVR TIPS is technically demanding and often requires percutaneous splenic vein access for portal venous recanalization. Selection of endovascular PVT treatment varies with the age (acute or chronic) and the extent of thrombus, along with presenting symptoms and transplant candidacy.
Topics: Humans; Liver Cirrhosis; Portal Vein; Portasystemic Shunt, Transjugular Intrahepatic; Thrombosis; Treatment Outcome
PubMed: 34654971
DOI: 10.1007/s11894-021-00826-1 -
Zentralblatt Fur Chirurgie Oct 2013The shunt thrombosis is the most frequent complication of dialysis shunts in haemodialysis patients. Morphological reasons are the main causes of shunt occlusion. A... (Comparative Study)
Comparative Study
INTRODUCTION
The shunt thrombosis is the most frequent complication of dialysis shunts in haemodialysis patients. Morphological reasons are the main causes of shunt occlusion. A critical evaluation of this aspect is presented on the basis of our own experience.
PATIENTS AND METHODS
A retrospective study investigated our own procedure of 136 operations between 2007 and 2011 on occluded haemodialysis shunts of the arm. The patient population comprised 49 thrombosed Cimino shunts, 64 PTFE and 23 occluded venous shunts for haemodialysis within a period of four weeks. The thrombosed PTFE shunts showed a recurrence rate of 48 %. There was a maximum of 9 previous operations on renewed occluded shunts. For the patency rates, the reocclusions and the intraoperative abandoning of the shunt were added. Preoperative duplex and angiography were performed on average in 20 % all of the cases.
RESULTS
All of the occluded Cimino shunts were treated successfully by thrombectomy in addition to a new anastomosis (38 out of 49, 78 %). The thrombosed PTFE loops for thrombectomy alone in 6 of 11 cases (54 %) and with additive corrections of the anastomosis showed in conclusion a patency rate of 64 % (16 out of 25). A complete new shunt reconstruction of the occluded PTFE shunts was necessary in 14 cases (22 %) and achieved patency rate of 85 %. For the venous loops anastomosis corrections were successful in 8 of 11 cases (72 %). The complete new shunt reconstructions, over bypass procedures or graft interpositions showed the best statistically significant results (χ2 = 3.9; p < 0.05) in comparison to the other procedures. Concerning time management both the day Monday and the weekend were troublesome.
CONCLUSION
The creation of a new anastomosis is the preferred method in the treatment of an occluded Cimino shunt. The sole thrombectomy and correction of the venous anastomosis is often insufficient. The most important aspect in cases of occluded PTFE loops is a completely new shunt reconstruction including interposition and over bypass. The need to perform the operations in good time is obvious, but not necessary in every case at night.
Topics: Anastomosis, Surgical; Arteriovenous Shunt, Surgical; Equipment Design; Female; Germany; Graft Occlusion, Vascular; Humans; Male; Middle Aged; Polytetrafluoroethylene; Recurrence; Renal Dialysis; Reoperation; Retrospective Studies; Thrombectomy; Thrombosis; Veins
PubMed: 24150806
DOI: 10.1055/s-0032-1328342 -
World Journal For Pediatric &... May 2018Shunt thrombosis is a significant cause of morbidity and mortality after systemic-to-pulmonary artery shunt (SPS) placement. Concurrent procedures with placement of SPS...
BACKGROUND
Shunt thrombosis is a significant cause of morbidity and mortality after systemic-to-pulmonary artery shunt (SPS) placement. Concurrent procedures with placement of SPS may require cardiopulmonary bypass (CPB). Cardiopulmonary bypass is known to cause bleeding and platelet dysfunction in infants, which may protect from early shunt thrombosis. We hypothesized that infants undergoing SPS placement on CPB have a lower incidence of early shunt thrombosis.
METHODS
Retrospective cohort study of infants undergoing SPS placement from January 2008 to December 2014 was performed. Patients with and without early shunt thrombosis and on or off CPB were compared using the Mann-Whitney U test or Fisher exact test. Multivariable regression analysis was performed to identify independent predictors of early shunt thrombosis and to assess effect of CPB independent of other factors.
RESULTS
Seventy-five infants underwent SPS placement during the study period (on CPB, n = 25; off CPB, n = 50). Operative mortality was 11% (8/75). Nine (12%) patients developed early shunt thrombosis, all of whom had shunt placement off CPB. Independent risk factors for early shunt thrombosis were identified to be SPS placement off CPB ( P = .011), prematurity ( P = .034), and competitive antegrade pulmonary blood flow ( P = .038).
CONCLUSION
Prematurity, competitive antegrade pulmonary blood flow, and shunt placement off CPB lead to higher risk of early shunt thrombosis. We speculate that the protection offered by use of CPB may be accounted for by the associated complex coagulopathy and platelet dysfunction associated with CPB.
Topics: Cardiopulmonary Bypass; Female; Humans; Infant, Newborn; Lung; Male; Multivariate Analysis; Postoperative Complications; Pulmonary Artery; Retrospective Studies; Risk Factors; Thrombosis; Treatment Outcome; Vascular Surgical Procedures
PubMed: 29692234
DOI: 10.1177/2150135118755985 -
Cerebrovascular Diseases (Basel,... 2014The efficacy of cerebrospinal fluid shunting to reduce intracranial hypertension and prevent fatal brain herniation in acute cerebral venous thrombosis (CVT) is unknown. (Review)
Review
BACKGROUND AND PURPOSE
The efficacy of cerebrospinal fluid shunting to reduce intracranial hypertension and prevent fatal brain herniation in acute cerebral venous thrombosis (CVT) is unknown.
METHOD
From the International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT) and a systematic literature review, we retrieved acute CVT patients treated only with shunting (external ventricular drain, ventriculoperitoneal or ventriculojugular shunt). Outcome was classified at 6 months and final follow-up by the modified Rankin Scale (mRS).
RESULTS
15 patients were collected (9 from the ISCVT and 6 from the review) who were treated with a shunt (external ventricular drain in 6 patients, a ventriculoperitoneal shunt in 8 patients or an unspecified type of shunt in another one). Eight patients (53.3%) regained independence (mRS 0-2), while 2 patients (13.3%) were left with a severe handicap (mRS 4-6) and 4 (26.7%) died despite treatment. Five patients with parenchymal lesions were shunted within 48 h from admission deterioration, 4 with an external ventricular drain: 2 (40%) recovered to independence, 2 (40%) had a severe handicap and 1 (20%) died. In contrast, all 3 patients with intracranial hypertension and no parenchymal lesions receiving a ventriculoperitoneal shunt later than 48 h regained independence.
CONCLUSION AND IMPLICATIONS
A quarter of acute CVT patients treated with a shunt died, and only half regained independence. With the limitation of the small number of subjects, this review suggests that shunting does not appear to be effective in preventing death from brain herniation in acute CVT. We cannot exclude that shunting may benefit patients with sustained intracranial hypertension and no parenchymal lesions.
Topics: Adolescent; Adult; Aged; Brain Damage, Chronic; Brain Edema; Cerebral Veins; Cerebrospinal Fluid Shunts; Child; Child, Preschool; Encephalocele; Female; Humans; Infant; Intracranial Hypertension; Intracranial Thrombosis; Male; Middle Aged; Severity of Illness Index; Sinus Thrombosis, Intracranial; Treatment Outcome; Venous Thrombosis; Young Adult
PubMed: 24356100
DOI: 10.1159/000356524 -
Techniques in Vascular and... Dec 2008Significantly improved long-term patency can be achieved with transjugular intrahepatic portosystemic shunt (TIPS) endografts compared to conventional bare stents. In... (Review)
Review
Significantly improved long-term patency can be achieved with transjugular intrahepatic portosystemic shunt (TIPS) endografts compared to conventional bare stents. In the USA, approximately 80% of TIPS procedures are performed using these devices. The phenomenon of early shunt thrombosis with TIPS created with bare stent TIPS, attributed to biliary fistulae, is seldom observed in patients with TIPS endografts. Intrashunt stenoses within the polytetrafluoroethylene-lined conduit are also rare. However, as with shunts created with bare stents, distinct patterns of dysfunction can occur with TIPS endografts. Some of these are inherent to the learning curve of placing these devices and others are secondary to device design. The interventional radiologist needs to be aware of these patterns of shunt dysfunction and have a systematic approach to their management.
Topics: Alloys; Biliary Fistula; Humans; Hypertension, Portal; Magnetic Resonance Imaging; Polytetrafluoroethylene; Portasystemic Shunt, Transjugular Intrahepatic; Portography; Prosthesis Design; Radiography, Interventional; Stents; Thrombosis; Treatment Outcome
PubMed: 19527847
DOI: 10.1053/j.tvir.2009.04.003 -
Techniques in Vascular and... Mar 2017Because a patent access is the lifeline for a dialysis patient, access declotting is extremely important. Before embarking on a declot, it is important to evaluate the... (Review)
Review
Because a patent access is the lifeline for a dialysis patient, access declotting is extremely important. Before embarking on a declot, it is important to evaluate the patient for potential contraindications such as pulmonary hypertension, right-to-left shunts and access infection in order to be able to avoid potential complications such as symptomatic pulmonary embolism, stroke, and sepsis. Multiple methods to perform a percutaneous declot exist. Four common methods are described here. We also discuss how to avoid causing an arterial embolism and how to treat it if it does occur.
Topics: Aged; Aged, 80 and over; Angiography; Arteriovenous Shunt, Surgical; Blood Vessel Prosthesis Implantation; Embolism; Endovascular Procedures; Female; Graft Occlusion, Vascular; Humans; Iatrogenic Disease; Kidney Failure, Chronic; Male; Middle Aged; Renal Dialysis; Risk Factors; Thrombectomy; Thrombolytic Therapy; Thrombosis; Treatment Outcome; Ultrasonography; Vascular Patency
PubMed: 28279408
DOI: 10.1053/j.tvir.2016.11.007