Ventriculoatrial shunt placement via internal jugular vein using a modified 8F vascular access sheath: A technical note

Ventriculoatrial (VA) shunting is a valuable alternative when ventriculoperitoneal (VP) shunting is contraindicated. We describe a modified technique for VA shunt placement using a standard, non-peel-away 8F vascular access sheath, adapted intraoperatively into a functional peel-away system using a simple blade modification. A 26-year-old male with a chronically infected, exteriorised left VP shunt underwent conversion to a left-sided VA shunt. Through a 2.5 cm neck incision, the internal jugular vein (IJV) was accessed under direct vision using a Seldinger technique, without ultrasound or fluoroscopic guidance. The distal catheter was advanced using the sternal angle as an unvalidated, pragmatic surface landmark for insertion length; postoperative chest radiography confirmed the catheter tip lying at approximately T3-T4 level, within the superior vena cava, proximal to the accepted cavoatrial target. This technique avoids venous tributary sacrifice and reduces neck dissection using universally available equipment, offering a feasible, though imprecisely targeted and fluoroscopy-free, option where dedicated peel-away introducers and image guidance are unavailable. The postoperative course was uneventful. At 3-month follow-up, the patient had a Glasgow Outcome Scale (GOS) score of 5. No thrombotic events or cardiac arrhythmias were observed during the follow-up period.