Long Life Efficient Permcath Fibrin Sheath Angioplasty

Background: Fibrin sheath formation around long-term haemodialysis catheter is a common cause of failed dialysis access. The sheath begins as a thrombus containing some fibrin in the first few days and transforms to a cellular-collagen tissue after 1 week. Upon catheter removal, the sheath tends to remain in the vein instead of attaching to the catheter. Method(s): The topic discuss 2 years experiences of dealing with 150 permcath insertion and exchange at Vascular access center in Davita care dialysis center, Jeddah, Saudi Arabia. Treatment options include pharmacological and mechanical methods. Pharmacological therapy involves instillation of urokinase (5,000 units or above) or tissue plasminogen activator (2.5 mg in 50 mls normal saline over 3 hours) to lyse the thrombus. Mechanical treatment includes catheter exchange, fibrin sheath disruption using guide wire and angioplasty balloon, before the permcath. Removal, 0.035 Guide wire was passed through the arterial red line of the catheter. The Catheter is freed from the cuff adhesion and pulled out till the tip to be kept at the vein inlet. Angiogram to be done. Result(s): a fibrin sheath was present,in 50 patients with malfunctioning permcath. 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 disruption of the fibrin sheath. Conclusion(s): The result of our study is, disruption of fibrin sheath in malfunctioning permcath can keep using the same side of vein insertion specially for patient with poor chances of AVF creation avoiding central venous stenosis and preserving efficient hemodialysis access.

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Artikel online veröffentlicht:
11. Mai 2021