title: Transvenous removal of fibrin sheaths from tunneled hemodialysis catheters.
abstract: OBJECTIVE
  Long-term hemodialysis catheters are prone to significant dysfunction due to fibrin accumulation around their tips. The authors assessed the efficacy of transvenous snare removal of fibrin to prolong function of these catheters.
  
  
  METHODS
  Twenty-four procedures were performed in 20 patients with tunneled hemodialysis central venous catheters. Technical success was gauged by venography and the ability to infuse and aspirate catheters. Durable efficacy was assessed by improvement in hemodialysis.
  
  
  RESULTS
  Twenty-two of 24 procedures were performed successfully. In two cases residual material remained despite repeated stripping. Mean preprocedure hemodialysis blood-liters processed per hour increased from 15.1 to 19.1 L/h in the first dialysis session after stripping, and blood flow rates of 300 mL/min or greater were restored. By the fifth dialysis session after stripping, the blood-liters processed per hour dropped to 15.9 L/h as catheter flow rates returned to unacceptable levels.
  
  
  CONCLUSIONS
  Percutaneous fibrin removal with a loop snare provides no durable benefit in improving function of failing hemodialysis catheters.
authors.affiliation: Department of Radiology, University of Pennsylvania Medical Center, Hospital of the University of Pennsylvania, Philadelphia 19104, USA.
authors.forename: Z J
authors.initials: ZJ
authors.lastname: Haskal
authors.forename: V H
authors.initials: VH
authors.lastname: Leen
authors.forename: C
authors.initials: C
authors.lastname: Thomas-Hawkins
authors.forename: R D
authors.initials: RD
authors.lastname: Shlansky-Goldberg
authors.forename: R A
authors.initials: RA
authors.lastname: Baum
authors.forename: M C
authors.initials: MC
authors.lastname: Soulen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001769:Blood; D002405:Catheterization, Central Venous / Q000295:instrumentation*; D002408:Catheters, Indwelling; D015331:Cohort Studies; D005260:Female; D005337:Fibrin; D018056:Hemorheology; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D010690:Phlebography; D006435:Renal Dialysis / Q000295:instrumentation* / Q000379:methods; D012212:Rheology; D013396:Suction; D013499:Surface Properties; D013927:Thrombosis / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D005337:Fibrin