Restoration of Patency in Failing Tunneled Hemodialysis Catheters: A Comparison of Catheter Exchange, Exchange and Balloon Disruption of the Fibrin Sheath, and Femoral Stripping

Abstract

To compare median patency times after treatment of malfunctioning tunneled hemodialysis catheters by one of three techniques: over-the-wire catheter exchange (CE), fibrin sheath stripping (FSS) from a femoral vein approach, and over-the-wire catheter removal with balloon dilation of fibrin sheath (DFS) followed by catheter replacement with use of the same tract. Retrospective study was conducted of 66 consecutive procedures performed over a period of 47 months for poor flow through tunneled hemodialysis catheters despite tissue plasminogen activator infusion trials (CE, n=33; FSS, n=18; DFS, n=15). Baseline parameters (time since initial catheter placement, number of previous catheter interventions, catheter access site, and patient age and sex) were recorded to identify possible pretreatment differences among groups. Outcome comparison was based on duration of adequate catheter function on dialysis during follow-up. No significant differences in baseline parameters were identified among the three groups (P>.05). Mean follow-up duration (67+/-89 days; range, 0-398 d) was similar among the three groups. The immediate technical success rate was 100%, and there were no complications. Cumulative catheter patency rates were 73% (CE), 72% (FSS), and 65% (DFS) at 1 month; 43% (CE), 60% (FSS), and 39% (DFS) at 3 months; and 28% (CE), 45% (FSS), and 39% (DFS) at 6 months. Median duration of patency was similar among groups (P=.60). All three therapies were equivalent in terms of immediate technical success, complication rates, and durability of catheter function during later follow-up. Hence, when one technique is chosen over another, factors other than the period of secondary patency should be considered, such as cost and patient and physician preference.