Percutaneous Transluminal Angioplasty of Fibrin Sheath with Removal or Exchange of Tunneled Hemodialysis Catheters

Bipin Saroha*

Tunneled dialysis catheters are widely used in the patient population with end stage renal disease (ESRD) undergoing hemodialysis (HD). These patients are usually in the process of being evaluated for arteriovenous fistula formation, and a tunneled catheter is placed in the interim. Catheter maintenance and complications (including infection, displacement, or failure to dialyze) represent a significant burden for these individuals. At our institution we noted a sizable proportion of patients presenting with catheter malfunction who required intervention, with the majority shown to have fibrin sheath formation. Retrospective review of 150 patients presenting with catheter malfunction demonstrated greater than 91% developed fibrin sheath. Subsequent catheter exchange with angioplasty to disrupt the fibrin sheath was performed, and functionality of the new catheter was confirmed with repeated rapid flushing.