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Int J Angiol 2012; 21(03): 129-134
DOI: 10.1055/s-0032-1324735
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Fibrin Sheath Angioplasty: A Technique to Prevent Superior Vena Cava Stenosis Secondary to Dialysis Catheters

Robert I. Hacker
1   Division of Vascular Surgery, North Shore-Long Island Jewish Health System, Manhasset, New York
,
Lorena De Marco Garcia
1   Division of Vascular Surgery, North Shore-Long Island Jewish Health System, Manhasset, New York
,
Ankur Chawla
1   Division of Vascular Surgery, North Shore-Long Island Jewish Health System, Manhasset, New York
,
Thomas F. Panetta
1   Division of Vascular Surgery, North Shore-Long Island Jewish Health System, Manhasset, New York
› Author Affiliations
Further Information

Publication History

Publication Date:
19 August 2012 (online)

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Abstract

Fibrin sheaths are a heterogeneous matrix of cells and debris that form around catheters and are a known cause of central venous stenosis and catheter failure. A total of 50 cases of central venous catheter fibrin sheath angioplasty (FSA) after catheter removal or exchange are presented. A retrospective review of an outpatient office database identified 70 eligible patients over a 19-month period. After informed consent was obtained, the dialysis catheter exiting the skin was clamped, amputated, and a wire was inserted. The catheter was then removed and a 9-French sheath was inserted into the superior vena cava, a venogram was performed. If a fibrin sheath was present, angioplasty was performed using an 8 × 4 or 10 × 4 balloon along the entire length of the fibrin sheath. A completion venogram was performed to document obliteration of the sheath. During the study, 50 patients were diagnosed with a fibrin sheath, and 43 had no pre-existing central venous stenosis. After FSA, 39 of the 43 patient's (91%) central systems remained patent without the need for subsequent interventions; 3 patients (7%) developed subclavian stenoses requiring repeat angioplasty and stenting; 1 patent (2.3%) developed an occlusion requiring a reintervention. Seven patients with prior central stenosis required multiple angioplasties; five required stenting of their central lesions. Every patient had follow-up fistulograms to document long-term patency. We propose that FSA is a prudent and safe procedure that may help reduce the risk of central venous stenosis from fibrin sheaths due to central venous catheters.

Keywords

inferior vena cava thrombosis - percutaneous - proximal - renal failure - subclavian stenosis - vascular access - deep vein thrombosis
 

  • References

  • 1 Dwyer A. Surface-treated catheters—a review. Semin Dial 2008; 21 (6) 542-546
    CrossrefPubMedGoogle Scholar
  • 2 Oliver MJ, Mendelssohn DC, Quinn RR , et al. Catheter patency and function after catheter sheath disruption: a pilot study. Clin J Am Soc Nephrol 2007; 2 (6) 1201-1206
    CrossrefPubMedGoogle Scholar
  • 3 Centers for Medicare and Medicaid Services . Office of Clinical Standards and Quality: 2004 Annual Report: The ESRD Clinical Performance Measures Project, Baltimore, Department of Health and Human Services, 2004
  • 4 National Kidney Foundation. KDOQI Clinical Practice Guideline and Clinical Practice Recommendations for 2006 updates: Hemodialysis Adequacy, Peritoneal Dialysis adequacy and vascular access. Am J Kidney Dis 2006; 48: s1-s322
    CrossrefPubMedGoogle Scholar
  • 5 Jefferys A, Chow JS, Suranyi MG. Acute vascular access catheters for haemodialysis: complications limiting technique survival. Nephrology (Carlton) 2003; 8 (1) 16-20
    CrossrefPubMedGoogle Scholar
  • 6 Pieters P. Venous Catheters. New York, NY: Thieme Medical Publishers; 2003
    Article in Thieme ConnectGoogle Scholar
  • 7 Lloyd DA, Shanbhogue LK, Doherty PJ, Sunderland D, Hart CA, Williams DF. Does the fibrin coat around a central venous catheter influence catheter-related sepsis?. J Pediatr Surg 1993; 28 (3) 345-348 , discussion 348–349
    CrossrefPubMedGoogle Scholar
  • 8 Xiang DZ, Verbeken EK, Van Lommel AT, Stas M, De Wever I. Composition and formation of the sleeve enveloping a central venous catheter. J Vasc Surg 1998; 28 (2) 260-271
    CrossrefPubMedGoogle Scholar
  • 9 Hamilton HC, Foxcroft DR. Central venous access sites for the prevention of venous thrombosis, stenosis and infection in patients requiring long-term intravenous therapy. Cochrane Database Syst Rev 2007; (3) CD004084
    PubMedGoogle Scholar
  • 10 Yevzlin AS. Hemodialysis catheter-associated central venous stenosis. Semin Dial 2008; 21 (6) 522-527
    CrossrefPubMedGoogle Scholar
  • 11 MacRae JM, Ahmed A, Johnson N, Levin A, Kiaii M. Central vein stenosis: a common problem in patients on hemodialysis. ASAIO J 2005; 51 (1) 77-81
    CrossrefPubMedGoogle Scholar
  • 12 Keller JE, Hindman JW, Mehall JR, Smith SD. Enoxaparin inhibits fibrin sheath formation and decreases central venous catheter colonization following bacteremic challenge. Crit Care Med 2006; 34 (5) 1450-1455
    CrossrefPubMedGoogle Scholar
  • 13 Marx AB, Landmann J, Harder FH. Surgery for vascular access. Curr Probl Surg 1990; 27 (1) 1-48
    PubMedGoogle Scholar
  • 14 Schwab SJ, Quarles LD, Middleton JP, Cohan RH, Saeed M, Dennis VW. Hemodialysis-associated subclavian vein stenosis. Kidney Int 1988; 33 (6) 1156-1159
    CrossrefPubMedGoogle Scholar
  • 15 Hoen B, Paul-Dauphin A, Hestin D, Kessler M. EPIBACDIAL: a multicenter prospective study of risk factors for bacteremia in chronic hemodialysis patients. J Am Soc Nephrol 1998; 9 (5) 869-876
    PubMedGoogle Scholar
  • 16 Lumsden AB, MacDonald MJ, Isiklar H , et al. Central venous stenosis in the hemodialysis patient: incidence and efficacy of endovascular treatment. Cardiovasc Surg 1997; 5 (5) 504-509
    CrossrefPubMedGoogle Scholar
  • 17 Prandoni P, Polistena P, Bernardi E , et al. Upper-extremity deep vein thrombosis. Risk factors, diagnosis, and complications. Arch Intern Med 1997; 157 (1) 57-62
    CrossrefPubMedGoogle Scholar
  • 18 Merport M, Murphy TP, Egglin TK, Dubel GJ. Fibrin sheath stripping versus catheter exchange for the treatment of failed tunneled hemodialysis catheters: randomized clinical trial. J Vasc Interv Radiol 2000; 11 (9) 1115-1120
    CrossrefPubMedGoogle Scholar
  • 19 Janne d'Othée B, Tham JC, Sheiman RG. Restoration of patency in failing tunneled hemodialysis catheters: a comparison of catheter exchange, exchange and balloon disruption of the fibrin sheath, and femoral stripping. J Vasc Interv Radiol 2006; 17 (6) 1011-1015
    CrossrefPubMedGoogle Scholar
  • 20 Santilli J. Fibrin sheaths and central venous catheter occlusions: diagnosis and management. Tech Vasc Interv Radiol 2002; 5 (2) 89-94
    CrossrefPubMedGoogle Scholar
  • 21 Reddy AS, Lang EV, Cutts J, Loh S, Rosen MP. Fibrin sheath removal from central venous catheters: an internal snare manoeuvre. Nephrol Dial Transplant 2007; 22 (6) 1762-1765
    CrossrefPubMedGoogle Scholar
  • 22 Gonsalves CF, Eschelman DJ, Sullivan KL, DuBois N, Bonn J. Incidence of central vein stenosis and occlusion following upper extremity PICC and port placement. Cardiovasc Intervent Radiol 2003; 26 (2) 123-127
    CrossrefPubMedGoogle Scholar
  • 23 Barrett N, Spencer S, McIvor J, Brown EA. Subclavian stenosis: a major complication of subclavian dialysis catheters. Nephrol Dial Transplant 1988; 3 (4) 423-425
    CrossrefPubMedGoogle Scholar
  • 24 Brismar BO, Hårdstedt C, Jacobson S. Diagnosis of thrombosis by catheter phlebography after prolonged central venous catheterization. Ann Surg 1981; 194 (6) 779-783
    CrossrefPubMedGoogle Scholar
  • 25 Kundu S. Central venous disease in hemodialysis patients: prevalence, etiology and treatment. J Vasc Access 2010; 11 (1) 1-7
    PubMedGoogle Scholar
  • 26 Fillinger MF, Reinitz ER, Schwartz RA , et al. Graft geometry and venous intimal-medial hyperplasia in arteriovenous loop grafts. J Vasc Surg 1990; 11 (4) 556-566
    CrossrefPubMedGoogle Scholar
  • 27 Dethlefsen SM, Shepro D, D'Amore PA. Comparison of the effects of mechanical stimulation on venous and arterial smooth muscle cells in vitro. J Vasc Res 1996; 33 (5) 405-413
    CrossrefPubMedGoogle Scholar
  • 28 Liangos O, Gul A, Madias NE, Jaber BL. Long-term management of the tunneled venous catheter. Semin Dial 2006; 19 (2) 158-164
    CrossrefPubMedGoogle Scholar
  • 29 Schon D, Whittman D. Managing the complications of long-term tunneled dialysis catheters. Semin Dial 2003; 16 (4) 314-322
    CrossrefPubMedGoogle Scholar
  • 30 Hoshal Jr VL, Ause RG, Hoskins PA. Fibrin sleeve formation on indwelling subclavian central venous catheters. Arch Surg 1971; 102 (4) 353-358
    CrossrefPubMedGoogle Scholar
  • 31 Suhocki PV, Conlon Jr PJ, Knelson MH, Harland R, Schwab SJ. Silastic cuffed catheters for hemodialysis vascular access: thrombolytic and mechanical correction of malfunction. Am J Kidney Dis 1996; 28 (3) 379-386
    CrossrefPubMedGoogle Scholar
  • 32 Duszak Jr R, Haskal ZJ, Thomas-Hawkins C , et al. Replacement of failing tunneled hemodialysis catheters through pre-existing subcutaneous tunnels: a comparison of catheter function and infection rates for de novo placements and over-the-wire exchanges. J Vasc Interv Radiol 1998; 9 (2) 321-327
    CrossrefPubMedGoogle Scholar
  • 33 Garofalo RS, Zaleski GX, Lorenz JM, Funaki B, Rosenblum JD, Leef JA. Exchange of poorly functioning tunneled permanent hemodialysis catheters. AJR Am J Roentgenol 1999; 173 (1) 155-158
    CrossrefPubMedGoogle Scholar
  • 34 Merport M, Murphy TP, Egglin TK, Dubel GJ. Fibrin sheath stripping versus catheter exchange for the treatment of failed tunneled hemodialysis catheters: randomized clinical trial. J Vasc Interv Radiol 2000; 11 (9) 1115-1120
    CrossrefPubMedGoogle Scholar
  • 35 Obialo CI, Conner AC, Lebon LF. Maintaining patency of tunneled hemodialysis catheters—efficacy of aspirin compared to warfarin. Scand J Urol Nephrol 2003; 37 (2) 172-176
    CrossrefPubMedGoogle Scholar
  • 36 Hoshal Jr VL, Ause RG, Hoskins PA. Fibrin sleeve formation on indwelling subclavian central venous catheters. Arch Surg 1971; 102 (4) 353-358
    CrossrefPubMedGoogle Scholar
  • 37 Forauer AR, Theoharis C. Histologic changes in the human vein wall adjacent to indwelling central venous catheters. J Vasc Interv Radiol 2003; 14 (9 Pt 1) 1163-1168
    CrossrefPubMedGoogle Scholar
  • 38 Berguer R, Higgins RF, Reddy DJ. Intimal hyperplasia. An experimental study. Arch Surg 1980; 115 (3) 332-335
    CrossrefPubMedGoogle Scholar
  • 39 Oguzkurt L, Ozkan U, Torun D, Tercan F. Does a fibrin sheath formed around a catheter embolize upon removal of the catheter?. Nephrol Dial Transplant 2007; 22 (12) 3677-3679
    CrossrefPubMedGoogle Scholar