title: Percutaneous fibrin sheath stripping versus transcatheter urokinase infusion for malfunctioning well-positioned tunneled central venous dialysis catheters: a prospective, randomized trial.
abstract: OBJECTIVE
  To compare central dialysis catheter patency rates after stripping procedures with those after urokinase (UK) infusion.
  
  
  METHODS
  Fifty-seven tunneled catheters with either (i) flow rates less than 250 mL/min and established baseline flow rates > or = 300 mL/min or (ii) flow rates 50 mL/min less than higher established baseline flows were prospectively randomized to undergo stripping procedures (n = 28) or UK infusion (n = 29) at 30,000 U/h via each port concurrently, for a total 250,000 U. Success and patency were determined by dialysis at normal flow rates (> or = 300 mL/min) or at the previously established higher baseline rate. Flow rates were monitored weekly. Primary patency ended with catheter malfunction or removal. Kaplan-Meier survival analysis was used to construct survival curves.
  
  
  RESULTS
  In the stripping group, initial clinical success was 89% (25 of 28). The 15-, 30-, and 45-day primary patency rates were 75% (n = 20), 52% (n = 13), and 35% (n = 8), respectively. The median duration of additional function was 32 days (95% CI: 18-48 d). In the UK group, initial clinical success was 97% (28 of 29). The 15-, 30-, and 45-day primary patency rates were 86% (n = 21), 63% (n = 13), and 48% (n = 9), respectively. The median duration of additional patency was 42 days (95% CI: 22-153 d). The Wilcoxon test for equality detected no significant difference in the survival curves for the two treatment groups (P = .236).
  
  
  CONCLUSIONS
  There is no significant difference in time to primary patency between the two methods. Both allow temporary catheter salvage in most patients.
authors.affiliation: Department of Radiology, Washington Hospital Center, DC 20010, USA. rjgdln@erols.com
authors.forename: R J
authors.initials: RJ
authors.lastname: Gray
authors.forename: A
authors.initials: A
authors.lastname: Levitin
authors.forename: D
authors.initials: D
authors.lastname: Buck
authors.forename: L C
authors.initials: LC
authors.lastname: Brown
authors.forename: Y H
authors.initials: YH
authors.lastname: Sparling
authors.forename: K A
authors.initials: KA
authors.lastname: Jablonski
authors.forename: A
authors.initials: A
authors.lastname: Fessahaye
authors.forename: A K
authors.initials: AK
authors.lastname: Gupta
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002405:Catheterization, Central Venous; D002408:Catheters, Indwelling; D016009:Chi-Square Distribution; D004868:Equipment Failure; D005260:Female; D005337:Fibrin; D006801:Humans; D008297:Male; D008875:Middle Aged; D010960:Plasminogen Activators / Q000008:administration & dosage*; D011446:Prospective Studies; D015641:Radiography, Interventional; D006435:Renal Dialysis / Q000295:instrumentation*; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D016896:Treatment Outcome; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage*; D014654:Vascular Patency
chemical_list: D005337:Fibrin; D010960:Plasminogen Activators; D014568:Urokinase-Type Plasminogen Activator