Florescu Marius C, Runge Joseph, Flora Maurino, Nio George, Lof John, Stolze Elizabeth, Fry Gretchen, Radio Stanley J, Foster Kirk W
1 Nephrology Division, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA.
2 UneMed Corporation, University of Nebraska Medical Center, Omaha, NE, USA.
J Vasc Access. 2018 Sep;19(5):484-491. doi: 10.1177/1129729818760978. Epub 2018 Mar 27.
We evaluated the location and structure of the fibrous sheath formed after the placement of tunneled, cuffed hemodialysis catheters in large animals, 70 kg pigs. We focused on describing the location of the fibrous sheath in relation to the catheter. Its location explains the fibrous sheath's ability to cause catheter dysfunction by covering the catheter exit ports located at the catheter's tip.
We used three animals. Each animal had a tunneled, cuffed, 15-French diameter hemodialysis catheter placed in the external jugular vein, with the tip at the junction of the superior vena cava and the right atrium. Two animals were sacrificed at 5 weeks and one animal at 17 weeks after catheter placement. The catheter and surrounding tissues were removed in one block. The fibrous sheath was dissected and longitudinally cut along the catheter to evaluate its extension in relation to the catheter. Relevant portions of the fibrous sheath were sent for pathology examination.
The fibrous sheath covered the catheter in its entire length and circumference. It started at the entry site and continued without any interruption along the entire length of the catheter, including the tip. Its average thickness is 1 mm and has an inner cellular/inflammatory layer comprising lymphocytes, plasma cells, neutrophils, macrophages, multinucleated giant cells, and spindled cells and an outer layer comprising a mixture of collagen and fibroblasts.
Our model showed that the fibrous sheath forms around all catheters and covers them in their entire length and circumference without any gaps.
我们评估了在70千克的大型动物猪体内植入带隧道带 cuff 的血液透析导管后形成的纤维鞘的位置和结构。我们着重描述纤维鞘相对于导管的位置。其位置解释了纤维鞘通过覆盖位于导管尖端的导管出口端口而导致导管功能障碍的能力。
我们使用了三只动物。每只动物均在颈外静脉植入一根带隧道带 cuff、直径为15法式的血液透析导管，导管尖端位于上腔静脉与右心房的交界处。在导管植入后5周处死两只动物，17周处死一只动物。将导管及周围组织整块取出。解剖纤维鞘并沿导管纵向切开，以评估其相对于导管的延伸情况。将纤维鞘的相关部分送去做病理检查。
纤维鞘在导管的整个长度和圆周上覆盖导管。它从进入部位开始，沿着导管的整个长度不间断地延续，包括尖端。其平均厚度为1毫米，有一个由淋巴细胞、浆细胞、中性粒细胞、巨噬细胞、多核巨细胞和梭形细胞组成的内细胞/炎症层以及一个由胶原蛋白和成纤维细胞混合组成的外层。
我们的模型表明，纤维鞘在所有导管周围形成，并在其整个长度和圆周上覆盖它们，没有任何间隙。
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