title: Fibrin sheath stripping versus catheter exchange for the treatment of failed tunneled hemodialysis catheters: randomized clinical trial.
abstract: OBJECTIVE
  To compare the effectiveness of two treatments for tunneled hemodialysis catheter malfunction: percutaneous fibrin sheath stripping (PFSS) and over-the-wire catheter exchange (EX).
  
  
  METHODS
  Adult patients with poorly functioning tunneled hemodialysis catheters (flow rates < 200 mL/min) were randomly assigned to receive either PFSS or EX. Over the course of 20 months, 30 patients (37 encounters) referred to a single institution met the inclusion criteria and consented to participate. PFSS employed transcatheter snares via femoral vein puncture, whereas EX was performed over a guide wire with use of fluoroscopic guidance. Patients were followed up to determine the duration of continued adequate hemodialysis via manipulated catheters for up to 4 months (primary outcome measure).
  
  
  RESULTS
  Overall technical success rate was 97%. Mean catheter patency for the PFSS group was 24.5 +/- 29.3 days, and 52.2 +/- 43 days for the EX group (P < .0001). After EX, patency rates at 1, 2, 3, and 4 months were 71%, 33%, 27%, and 27%, compared to 31%, 16%, 7%, and 0% after PFSS (P = .04, logrank test). Exchanged catheters were significantly more likely to be patent for as long as 4 months (23% versus 0%; P < .05, chi2 test).
  
  
  CONCLUSIONS
  Malfunctioning tunneled hemodialysis catheters treated by means of EX are significantly more likely to remain patent for up to 4 months than are those treated by means of PFSS. According to the results of this trial, PFSS should not be performed as a routine therapy for catheter malfunction.
authors.affiliation: Division of Vascular and Interventional Radiology, Rhode Island Hospital, Providence 02903, USA.
authors.forename: M
authors.initials: M
authors.lastname: Merport
authors.forename: T P
authors.initials: TP
authors.lastname: Murphy
authors.forename: T K
authors.initials: TK
authors.lastname: Egglin
authors.forename: G J
authors.initials: GJ
authors.lastname: Dubel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002405:Catheterization, Central Venous / Q000295:instrumentation*; D002408:Catheters, Indwelling; D016009:Chi-Square Distribution; D004868:Equipment Failure; D005260:Female; D005337:Fibrin; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015641:Radiography, Interventional; D006435:Renal Dialysis / Q000295:instrumentation*; D016896:Treatment Outcome; D014654:Vascular Patency
chemical_list: D005337:Fibrin