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Related Experiment Video

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Hickman Catheter Use for Long-Term Vascular Access in a Preclinical Swine Model

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Catheter patency and function after catheter sheath disruption: a pilot study.

Matthew J Oliver¹, David C Mendelssohn, Robert R Quinn

¹Sunnybrook Health Sciences Centre, Room A239, 2075 Bayview Avenue, Toronto, Canada M4N 3M5. matthew.oliver@sunnybrook.ca

Clinical Journal of the American Society of Nephrology : CJASN

|October 19, 2007

Summary

Disrupting fibrin sheaths around hemodialysis catheters with angioplasty balloons improves catheter function and extends patency. This technique offers a durable solution for refractory catheter dysfunction, enhancing treatment efficacy.

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Area of Science:

Nephrology
Vascular Access
Interventional Radiology

Background:

Fibrin sheaths frequently cause hemodialysis catheter dysfunction.
Previous studies on sheath disruption have limitations and suggest short-term patency.

Purpose of the Study:

To investigate the impact of angioplasty sheath disruption on hemodialysis catheter patency and function.
To evaluate the durability of catheter patency after sheath disruption.

Main Methods:

A randomized, controlled pilot trial involving 47 long-term hemodialysis patients with refractory catheter dysfunction.
Catheter dysfunction was addressed by guidewire exchange, with random assignment to angioplasty sheath disruption or no disruption.

Main Results:

Sheaths were present in 70% of patients.
The disruption group showed a trend towards longer time to repeat dysfunction (373 vs. 97.5 days) and catheter exchange (411 vs. 198 days).
Mean blood flow and urea reduction ratio were significantly higher in the disruption group. Patients without sheaths had better outcomes than those with undrupted sheaths.

Conclusions:

Angioplasty balloon disruption of fibrin sheaths leads to durable catheter patency.
This method modestly improves blood flow and clearance during catheter use.
Sheath disruption is an effective strategy for managing refractory hemodialysis catheter dysfunction.