Fibrin sleeve stripping for salvage of failing hemodialysis catheters: technique and initial results.
OBJECTIVE
To evaluate percutaneous fibrin sleeve stripping (PFSS) to prolong functional patency in failing hemodialysis catheters.


METHODS
Forty PFSS procedures were performed in 24 catheters in 23 consecutive patients with an inadequate blood flow rate (< 200 mL/min) during hemodialysis. The fibrin sleeve was mechanically stripped off the shaft of the catheter with a snare introduced via the common femoral vein. Durability of PFSS was determined with life-table analysis.


RESULTS
Median time from catheter placement to initial failure was 3.5 months (range, 5 days to 22 months). The technical success rate for PFSS was 100%; initial patency was restored in 39 of 40 procedures (98%), and no symptomatic pulmonary embolism occurred. Primary patency after single PFSS was 45% at 3 months and 28% at 6 months (median added patency, 2.8 months). Postprocedure secondary patency with multiple PFSS procedures was 83% at 3 months and 72% at 6 months (P = .01) (overall catheter patency, 90% at 6 months and 81% at 1 year [P < .001]).


CONCLUSIONS
Multiple PFSS procedures can prolong patency in hemodialysis catheters with a fibrin sleeve.
Department of Radiology, Medical College of Wisconsin, Milwaukee 53226, USA.
M R
MR
Crain
M W
MW
Mewissen
G J
GJ
Ostrowski
R
R
Paz-Fumagalli
R A
RA
Beres
R A
RA
Wertz
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001783:Blood Flow Velocity; D002405:Catheterization, Central Venous / Q000009:adverse effects; D002408:Catheters, Indwelling / Q000009:adverse effects*; D005260:Female; D005337:Fibrin; D006801:Humans; D008297:Male; D008875:Middle Aged; D011677:Punctures; D015641:Radiography, Interventional / Q000379:methods*; D006435:Renal Dialysis
D005337:Fibrin