Reddy Arra S, Lang Elvira V, Cutts Jennifer, Loh Shaun, Rosen Max P
Beth Israel Deaconess Medical Center, One Deaconess Road, Room 327C, Boston, MA 02215, USA.
Nephrol Dial Transplant. 2007 Jun;22(6):1762-5. doi: 10.1093/ndt/gfm154. Epub 2007 Apr 1.
Dysfunction of haemodialysis catheters is most commonly due to a narrowing of the catheter lumen and/or formation of a fibrin sheath around the catheter tip. Reported methods for restoring patency of the catheter lumen include passage of a J-tipped guide wire, passage of a biopsy brush through the catheter, or infusion of a thrombolytic agent into the catheter. While these methods are often effective, they suffer from several limitations. We present a minimally invasive technique to remove thrombi and debris from within the lumen of a partially thrombosed haemodialysis catheter while simultaneously stripping the fibrous sheath.
A 0.089 cm nitinol wire is bent to create a loop, which is then inserted via the catheters. Upon exiting the lumen of the catheters, the nitinol wire forces a snare open, which disrupts the fibrin sheath and catches intraluminal thrombi and debris. The technique requires no anaesthesia or recovery time.
Initial clinical success in our series was achieved in all patients (7/7) as evidenced by restoration of target flow rates on subsequent haemodialysis. None of the patients experienced any complications as a result of the procedure. The catheter 2-, 4-, and 6-week primary success rates were 100% (8/8), 100% (8/8), and 100% (8/8) respectively with a mean duration of 17.1 weeks (range 8-40 weeks).
The internal snare technique is an effective, inexpensive and minimally invasive approach to restoring patency to failed central venous access catheters.
血液透析导管功能障碍最常见的原因是导管内腔狭窄和/或导管尖端周围形成纤维蛋白鞘。报道的恢复导管内腔通畅的方法包括通过J形头导丝、将活检刷通过导管或向导管内注入溶栓剂。虽然这些方法通常有效，但它们存在一些局限性。我们提出一种微创技术，用于清除部分血栓形成的血液透析导管内腔内的血栓和碎片，同时剥离纤维鞘。
将一根0.089厘米的镍钛合金丝弯曲成一个环，然后通过导管插入。镍钛合金丝离开导管内腔时会撑开一个圈套器，破坏纤维蛋白鞘并捕获腔内血栓和碎片。该技术无需麻醉或恢复时间。
在我们的系列研究中，所有患者（7/7）均取得了初步临床成功，后续血液透析时目标流速恢复即为证明。没有患者因该操作出现任何并发症。导管在2周、4周和6周时的一次成功率分别为100%（8/8）、100%（8/8）和100%（8/8），平均持续时间为17.1周（范围8 - 40周）。
内部圈套器技术是一种有效、廉价且微创的方法，可恢复失败的中心静脉通路导管的通畅性。
