title: Stripping of failing haemodialysis catheters using the Ampltaz gooseneck snare.
abstract: The development of a fibrin sheath at the tip of a long-term haemodialysis catheter may lead to deteriorating blood flow rates, resulting in inadequate haemodialysis. Restoration of functional patency has been described using the technique of percutaneous fibrin sheath stripping (PFSS) using a wire snare device. Our purpose was to assess this technique within an established renal vascular access service. All catheters referred for the assessment of low blood flow rates on dialysis were considered for the procedure. Initial fluoroscopic assessment of the catheter was followed by stripping of the tip of the catheter using a gooseneck snare. Seventeen of 22 well-positioned catheters undergoing a single PFSS attempt were restored to function with a median prolongation of patency of 4.25 months. Two catheters underwent a second PFSS procedure providing additional patency. Nineteen of a total of 24 (79%) PFSS procedures successfully restored catheter function. Seven catheters with poorly positioned tips or a kink were not restored to functional patency using PFSS. Two patients developed a puncture site haematoma. No patient developed symptoms of pulmonary emoblism. In conclusion, PFSS restored function in 79% of attempts in well positioned catheters. The method is technically straightforward, with a low complication rate and has become a routine part of the renal vascular access service.
authors.affiliation: Department of Radiology, St Mary's Hospital, London, UK.
authors.forename: A G
authors.initials: AG
authors.lastname: Rockall
authors.forename: A
authors.initials: A
authors.lastname: Harris
authors.forename: C W
authors.initials: CW
authors.lastname: Wetton
authors.forename: D
authors.initials: D
authors.lastname: Taube
authors.forename: W
authors.initials: W
authors.lastname: Gedroyc
authors.forename: M A
authors.initials: MA
authors.lastname: Al-Kutoubi
mesh_terms: D002405:Catheterization, Central Venous / Q000295:instrumentation*; D004868:Equipment Failure; D005337:Fibrin; D005471:Fluoroscopy; D005500:Follow-Up Studies; D006801:Humans; D015641:Radiography, Interventional / Q000379:methods*; D006435:Renal Dialysis / Q000295:instrumentation*; D016896:Treatment Outcome
chemical_list: D005337:Fibrin