Radiology, Vol 198, 41-44, Copyright © 1996 by Radiological Society of North America

ARTICLES

Fibrin sleeve stripping for salvage of failing hemodialysis catheters: technique and initial results

MR Crain, MW Mewissen, GJ Ostrowski, R Paz-Fumagalli, RA Beres and RA Wertz
Department of Radiology, Medical College of Wisconsin, Milwaukee 53226, USA.

PURPOSE: To evaluate percutaneous fibrin sleeve stripping (PFSS) to prolong functional patency in failing hemodialysis catheters. MATERIALS AND METHODS: Forty PFSS procedures were performed in 24 catheters in 23 consecutive patients with an inadequate blood flow rate (< 200 mL/min) during hemodialysis. The fibrin sleeve was mechanically stripped off the shaft of the catheter with a snare introduced via the common femoral vein. Durability of PFSS was determined with life-table analysis. RESULTS: Median time from catheter placement to initial failure was 3.5 months (range, 5 days to 22 months). The technical success rate for PFSS was 100%; initial patency was restored in 39 of 40 procedures (98%), and no symptomatic pulmonary embolism occurred. Primary patency after single PFSS was 45% at 3 months and 28% at 6 months (median added patency, 2.8 months). Postprocedure secondary patency with multiple PFSS procedures was 83% at 3 months and 72% at 6 months (P = .01) (overall catheter patency, 90% at 6 months and 81% at 1 year [P < .001]). CONCLUSION: Multiple PFSS procedures can prolong patency in hemodialysis catheters with a fibrin sleeve.

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