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Beyond the 10-year barrier: ultrastructural insights into long-term tunneled catheter function from calcified
Yueqi Cao1, Bo Li1, Haiyan Chen1
1Department of Kidney Disease and Blood Purification Centre, 2nd Affiliated Hospital of Tianjin Medical University, Tianjin, PR China.
Insights
Long-term hemodialysis catheters develop fibrin sheath hyperplasia. Prolonged dwelling time correlates with more severe pathological changes, including degeneration and calcification, impacting catheter function.
Area of Science:
- Nephrology
- Biomaterials Science
- Pathology
Background:
- Tunneled-cuffed catheters (TCCs) are crucial for maintenance hemodialysis.
- Catheter dysfunction is a common complication, often linked to fibrin sheath formation.
- The ultrastructural changes in long-term TCC fibrin sheaths are not well-documented.
Purpose of the Study:
- To investigate the ultrastructural characteristics of fibrin sheaths in malfunctioning TCCs.
- To correlate dwelling duration with pathological changes in fibrin sheaths.
Main Methods:
- Analysis of fibrin sheath specimens from 4 malfunctioning TCCs via scanning electron microscopy.
- Supplementation with energy-dispersive X-ray spectroscopy and hematoxylin-eosin staining.
- Catheter exchange performed under digital subtraction angiography guidance.
Main Results:
- All specimens showed fibrous tissue hyperplasia.
- Longer dwelling duration catheters exhibited myofiber degeneration and calcification within fibrin sheaths.
- Shorter dwelling duration catheters showed predominantly exudates and inflammatory infiltration.
Conclusions:
- Fibrin sheath hyperplasia is a consistent finding in long-term hemodialysis catheters.
- Prolonged catheter dwelling time is associated with increased severity of fibrin sheath pathology.
- These ultrastructural changes may contribute to TCC dysfunction.
Abstract:
Tunneled-cuffed catheters (TCCs) remain a primary vascular access modality for patients requiring maintenance hemodialysis, yet catheter dysfunction is a frequent and challenging complication. Although the factors contributing to catheter dysfunction are well recognized, the ultrastructural changes of fibrin sheaths in long-term indwelling catheters have not been systematically documented in the literature. Herein, we present 4 cases of malfunctioning subcutaneous TCCs of varying dwelling durations. Catheter exchange was performed under digital subtraction angiography guidance, and fibrin sheath specimens were collected for analysis. Ultrastructural assessment was conducted via scanning electron microscopy, supplemented with energy-dispersive X-ray spectroscopy and hematoxylin-eosin staining. Fibrous tissue hyperplasia was observed in all 4 specimens. Specimens from the 2 catheters with longer dwelling durations exhibited myofiber degeneration within the fibrin sheaths, accompanied by tissue calcification. In contrast, fibrin sheaths from the 2 catheters with shorter dwelling durations were predominantly characterized by exudates and inflammatory cellular infiltration. Fibrin sheath hyperplasia is a consistent pathological feature in long-term hemodialysis catheters. These findings suggest that prolonged catheter dwelling time correlates with progressively more severe pathological changes in the fibrin sheath.
