Efficacy of percutaneous fibrin sheath stripping in restoring patency of tunneled hemodialysis catheters.

OBJECTIVE: Our objective was to determine the effectiveness of percutaneous fibrin sheath stripping as a method of restoring function to failing tunneled hemodialysis catheters.

SUBJECTS AND METHODS: A total of 131 percutaneous fibrin sheath stripping procedures were performed on 100 failing tunneled hemodialysis catheters in 91 patients. Only the initial stripping procedure of the first catheter inserted in each patient was included for analysis. Patients were excluded if an additional cause of catheter failure was noted at the time of percutaneous fibrin stripping. Failure of the hemodialysis catheter was defined as inability to sustain an average blood flow rate of 250 ml/min or more in a hemodialysis session. Patients were followed up until the time of catheter failure, catheter removal, or a second stripping. Poststripping primary patency and complication rates were determined.

RESULTS: The technical success of the procedure was 95.6%. Median follow-up was 16 weeks (range, 0-128 weeks). The overall median duration of primary patency after the first stripping was 89 days (3 months). No statistically significant difference in primary patency rates was seen between patients who underwent fibrin sheath demonstration by contrast injection and those who did not (p = .71). Female patients were statistically more likely to have catheter failure after catheter stripping than were male patients (p = .02). The route of catheter insertion did not significantly influence poststripping patency rates. No complications were associated with the procedure.

CONCLUSION: Percutaneous fibrin sheath stripping is a safe, effective method of restoring patency to failing hemodialysis catheters when the failure is due to fibrin sheath formation and other causes are excluded.