Hacker Robert I, Garcia Lorena De Marco, Chawla Ankur, Panetta Thomas F
Division of Vascular Surgery, North Shore-Long Island Jewish Health System, Manhasset, New York.
Int J Angiol. 2012 Sep;21(3):129-34. doi: 10.1055/s-0032-1324735.
Fibrin sheaths are a heterogeneous matrix of cells and debris that form around catheters and are a known cause of central venous stenosis and catheter failure. A total of 50 cases of central venous catheter fibrin sheath angioplasty (FSA) after catheter removal or exchange are presented. A retrospective review of an outpatient office database identified 70 eligible patients over a 19-month period. After informed consent was obtained, the dialysis catheter exiting the skin was clamped, amputated, and a wire was inserted. The catheter was then removed and a 9-French sheath was inserted into the superior vena cava, a venogram was performed. If a fibrin sheath was present, angioplasty was performed using an 8 × 4 or 10 × 4 balloon along the entire length of the fibrin sheath. A completion venogram was performed to document obliteration of the sheath. During the study, 50 patients were diagnosed with a fibrin sheath, and 43 had no pre-existing central venous stenosis. After FSA, 39 of the 43 patient's (91%) central systems remained patent without the need for subsequent interventions; 3 patients (7%) developed subclavian stenoses requiring repeat angioplasty and stenting; 1 patent (2.3%) developed an occlusion requiring a reintervention. Seven patients with prior central stenosis required multiple angioplasties; five required stenting of their central lesions. Every patient had follow-up fistulograms to document long-term patency. We propose that FSA is a prudent and safe procedure that may help reduce the risk of central venous stenosis from fibrin sheaths due to central venous catheters.
纤维蛋白鞘是在导管周围形成的由细胞和碎片组成的异质基质，是中心静脉狭窄和导管功能障碍的已知原因。本文报告了50例在拔除或更换导管后进行中心静脉导管纤维蛋白鞘血管成形术（FSA）的病例。对一个门诊数据库进行回顾性分析，确定了19个月内70例符合条件的患者。在获得知情同意后，将透析导管在穿出皮肤处夹闭、截断，插入导丝。然后拔出导管，将一个9F鞘管插入上腔静脉，进行静脉造影。如果存在纤维蛋白鞘，则使用8×4或10×4的球囊沿纤维蛋白鞘全长进行血管成形术。进行完成静脉造影以记录鞘管闭塞情况。在研究期间，50例患者被诊断有纤维蛋白鞘，其中43例之前没有中心静脉狭窄。FSA术后，43例患者中有39例（91%）的中心静脉系统保持通畅，无需后续干预；3例患者（7%）出现锁骨下狭窄，需要重复血管成形术和支架置入术；1例患者（2.3%）出现闭塞，需要再次干预。7例之前有中心静脉狭窄的患者需要多次血管成形术；5例需要对其中心病变进行支架置入术。每位患者均接受随访瘘管造影以记录长期通畅情况。我们认为，FSA是一种谨慎且安全的手术，可能有助于降低中心静脉导管导致的纤维蛋白鞘引起的中心静脉狭窄风险。
