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    • Management of Catheter Related Fibrin Sheath by Balloon Disruption

    Mohamed El-Maadawy, MD, Ahmed Gamal, MD & Usama Lotfi, MD
    Department of Vascular Surgery, Faculty of Medicine - Cairo University

    Background: Catheter-based hemodialysis remains a distinct valid option in many patients with chronic kidney disease (CKD). Catheter related fibrin sheath (CRS) formation is responsible for a significant proportion of catheter dysfunction; moreover, the presence of CRS at the time of catheter exchange significantly reduces subsequent catheter function. Several strategies have been described for management of CRS. However, no consensus has been reached about the preferred technique, associated with the longest catheter patency. Aim of the study: We report our experience in management of tunneled hemodialysis CRS by means of balloon disruption followed by over guidewire catheter exchange. Patients and methods: Between November 2011 through March 2015, 26 patients (female, n=15; male, n=11) with end stage renal disease (ESRD) undergoing catheter-based hemodialysis (CBH) with age range from 25 to 77 years (mean, 50.8±13.1 years) were included in the study. The studied patients had episodes of catheter dysfunction with clinical and/or radiographic evidence consistent with the presence of a CRS on either the arterial and/or venous port. All patients were subjected to catheter directed balloon disruption of their CRS at the time of catheter exchange. Patients were followed-up prospectively for technical success, complications, catheter patency, and short-term outcome. Results: The technique was successful in all patients with adequate aspiration and infusion capabilities of both ports of the newly inserted catheters. No periprocedural complications were reported. Patients were followed for a minimum of six months to assess for recurrent catheter dysfunction, time to repeat catheter exchange, mean blood flow during hemodialysis treatment, and adverse events. Conclusion: Balloon disruption of CRS proved to be safe and effective in maintenance of vascular access with durable catheter patency. Additionally, the procedure can tackle concomitant central vein stenosis with eventual chance of future AV fistula creation. Key words: Tunneled hemodialysis catheters, catheter related fibrin sheath, balloon disruption. 

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