Balloon disruption of fibrin sheath in hemodialysis patients with malfunctioning tunneled central venous catheters / Diaa Fathy Khairy Adam ; Supervised Amr Abdulbaky , Hossam Zaghlol , Ahmed Mohamed Balboula

Thesis (M.Sc.) - Cairo University - Faculty of Medicine - Department of General Surgery

Background: Dialysis via tunneled central venous catheters is constantly being considered in a significant proportion of patients with end stage kidney disease (ESKD).Hemodialysis-catheter dysfunction is a common clinical scenario. Like other central venous devices, hemodialysis-catheters show a disposition for partial or complete thrombotic obstruction and catheter-related fibrin sheath (CRS) formation. The incidence of CRS development; following central venous instrumentation; is estimated to range from 42% to 100 %.( Lowder CA et al, 2000) This may remain clinically asymptomatic. However, CRS can eventually manifest clinically into a variety of complications. This includes withdrawal occlusion (oneway obstruction), total catheter occlusion, vein thrombosis, medication extravasation, pulmonary embolism at catheter removal, and predisposition to infection. Several strategies have been described to deal with CRS including thrombolytic therapy, stripping of the sheath, and disruption using wires And balloons, together with catheter exchange. Because fibrin sheath possess the tendency to recur, usually within weeks to a few months of the intervention, each of these methods has limitations.Using thrombolysis in managing CRS, although supported by good initial results, is criticized by low patency of catheters beyond 1 month. Mechanical removal of CRS by percutaneous loop snare has been reported in several reports with good early results. However, the evidence of procedure success predictors in the literature are limited. More important, although uncommonly recorded, there is a theoretical risk of inevitable pulmonary embolism by CRS fragments

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