Ultrasound-guided percutaneous ventriculoatrial shunt placement in pediatric hydrocephalus: Surgical outcomes and thrombotic complications.

OBJECTIVE: Ventriculoatrial shunts (VAS) are increasingly used as a salvage option in pediatric hydrocephalus when ventriculoperitoneal shunts (VPS) fail. Although ultrasound-guided percutaneous techniques facilitate catheter placement and reduce surgical trauma, the incidence and management of thrombotic complications remain insufficiently defined. METHODS: We retrospectively analyzed eight pediatric patients who underwent ultrasound-guided percutaneous VAS placement between January 2019 and December 2024. Demographic characteristics, etiology of hydrocephalus, operative details, and post-operative complications were evaluated, with a particular focus on thrombotic events. RESULTS: Patients underwent a mean of 3.8±1.3 VPS revisions before VAS placement. Myelomeningocele was the most common etiology (50%). The mean operative time was 75.6±13.9 min, and the mean intraoperative blood loss was 86.25±43.07 mL. Post-operative complications occurred in 3 patients (37.5%), including thrombotic events in 2 patients (25%) and infection in 1 patient (12.5%). One patient required early shunt removal due to thrombus formation with vegetation, whereas another developed late asymptomatic thrombosis requiring intervention. The internal jugular vein was the most commonly used access site. CONCLUSION: Ultrasound-guided percutaneous VAS placement is a feasible and minimally invasive alternative in selected pediatric patients. However, thrombotic complications may be more frequent than previously reported and can occur both early and late in the post-operative period. These findings highlight the need for standardized surveillance protocols and further investigation into prophylactic strategies, including antiplatelet therapy.