Merport M, Murphy T P, Egglin T K, Dubel G J
Division of Vascular and Interventional Radiology, Rhode Island Hospital, Providence 02903, USA.
J Vasc Interv Radiol. 2000 Oct;11(9):1115-20. doi: 10.1016/s1051-0443(07)61351-7.
To compare the effectiveness of two treatments for tunneled hemodialysis catheter malfunction: percutaneous fibrin sheath stripping (PFSS) and over-the-wire catheter exchange (EX).
Adult patients with poorly functioning tunneled hemodialysis catheters (flow rates < 200 mL/min) were randomly assigned to receive either PFSS or EX. Over the course of 20 months, 30 patients (37 encounters) referred to a single institution met the inclusion criteria and consented to participate. PFSS employed transcatheter snares via femoral vein puncture, whereas EX was performed over a guide wire with use of fluoroscopic guidance. Patients were followed up to determine the duration of continued adequate hemodialysis via manipulated catheters for up to 4 months (primary outcome measure).
Overall technical success rate was 97%. Mean catheter patency for the PFSS group was 24.5 +/- 29.3 days, and 52.2 +/- 43 days for the EX group (P < .0001). After EX, patency rates at 1, 2, 3, and 4 months were 71%, 33%, 27%, and 27%, compared to 31%, 16%, 7%, and 0% after PFSS (P = .04, logrank test). Exchanged catheters were significantly more likely to be patent for as long as 4 months (23% versus 0%; P < .05, chi2 test).
Malfunctioning tunneled hemodialysis catheters treated by means of EX are significantly more likely to remain patent for up to 4 months than are those treated by means of PFSS. According to the results of this trial, PFSS should not be performed as a routine therapy for catheter malfunction.
比较两种治疗隧道式血液透析导管故障的方法的有效性：经皮纤维蛋白鞘剥脱术（PFSS）和导丝导管置换术（EX）。
将隧道式血液透析导管功能不良（血流量<200 mL/分钟）的成年患者随机分配接受PFSS或EX治疗。在20个月的时间里，30例患者（37次就诊）转诊至单一机构，符合纳入标准并同意参与。PFSS通过股静脉穿刺采用经导管圈套器，而EX在透视引导下经导丝进行。对患者进行随访，以确定通过操作导管进行持续充分血液透析的持续时间，最长达4个月（主要结局指标）。
总体技术成功率为97%。PFSS组导管平均通畅时间为24.5±29.3天，EX组为52.2±43天（P<.0001）。EX术后1、2、3和4个月的通畅率分别为71%、33%、27%和27%，而PFSS术后分别为31%、16%、7%和0%（P=.04，对数秩检验）。置换后的导管在长达4个月内保持通畅的可能性显著更高（23%对0%；P<.05，卡方检验）。
与采用PFSS治疗的故障隧道式血液透析导管相比，采用EX治疗的导管在长达4个月内保持通畅的可能性显著更高。根据本试验结果，PFSS不应作为导管故障的常规治疗方法。
