Background: Vena cavasuperior syndrome is a well-known complication to ventriculoatrial shunts in children and adults. The basis for this is thrombosis.
Material and methods: A patient with hydrocephalus had a ventriculoatrial shunt in his first month of life. More than 30 years later he developed vena cava superior syndrome following abdominal surgery. Diagnostic venography revealed thrombosis in the proximal veins of his arms, neck and vena cava superior.
Results and interpretation: He was treated with catheter-directed thrombolysis with antegrade infusion of alteplase (Actilyse). Evaluation of thrombolytic treatment after one day revealed a significant stenosis in the superior caval vein in the same area as the shunt had ended. Venoplasty and stent implantation were performed, and an intraluminal diameter of 10 mm was reached. Complete thrombolysis was achieved after 48 hours' infusion of alteplase. His swellings subsided the following two weeks and control venography 6 months later showed no signs of rethrombosis or restenosis. His life-threatening condition was successfully treated with local thrombolytic therapy, venoplasty and stent implantation.