Stripping of failing haemodialysis catheters using the Ampltaz gooseneck snare

The development of a fibrin sheath at the tip of a long-term haemodialysis catheter may lead to deteriorating blood flow rates, resulting in inadequate haemodialysis. Restoration of functional patency has been described using the technique of percutaneous fibrin sheath stripping (PFSS) using a wire...

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Bibliographic Details
Published in:Clinical radiology 1997-08, Vol.52 (8), p.616-620
Main Authors: Rockall, A.G., Harris, A., Wetton, C.W.N., Taube, D., Gedroyc, W., Al-Kutoubi, M.A.
Format: Article
Language:English
Subjects:
Biological and medical sciences
Catheterization, Central Venous - instrumentation
Equipment Failure
Fibrin
Fluoroscopy
Follow-Up Studies
Humans
Investigative techniques of hemodynamics
Investigative techniques, diagnostic techniques (general aspects)
Kidney
Medical sciences
Radiography, Interventional - methods
Renal Dialysis - instrumentation
Treatment Outcome
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Summary:The development of a fibrin sheath at the tip of a long-term haemodialysis catheter may lead to deteriorating blood flow rates, resulting in inadequate haemodialysis. Restoration of functional patency has been described using the technique of percutaneous fibrin sheath stripping (PFSS) using a wire snare device. Our purpose was to assess this technique within an established renal vascular access service. All catheters referred for the assessment of low blood flow rates on dialysis were considered for the procedure. Initial fluoroscopic assessment of the catheter was followed by stripping of the tip of the catheter using a gooseneck snare. Seventeen of 22 well-positioned catheters undergoing a single PFSS attempt were restored to function with a median prolongation of patency of 4.25 months. Two catheters underwent a second PFSS procedure providing additional patency. Nineteen of a total of 24 (79%) PFSS procedures successfully restored catheter function. Seven catheters with poorly positioned tips or a kink were not restored to functional patency using PFSS. Two patients developed a puncture site haematoma. No patient developed symptoms of pulmonary embolism. In conclusion, PFSS restored function in 79% of attempts in well positioned catheters. The method is technically straightforward, with a low complication rate and has become a routine part of the renal vascular access service.
ISSN:0009-9260
1365-229X
DOI:10.1016/S0009-9260(97)80255-3