Fibrin Sheath Removal Techniques

Although autogenous arteriovenous fistula creation is the gold-standard dialysis access, catheters represent between 40% and 60% of dialysis access in the United States. Catheters are placed for a variety of reasons, commonly as temporary access for acute renal failure or as a bridge to a more permanent access in patients with end-stage renal disease. Fibrin sheaths represent a heterogeneous matrix of cells and debris that form around catheters and are a known common cause of catheter failure and central venous stenosis. Their formation is ubiquitous in the dialysis population, occurring with 80–100% of catheters within 1 week of implantation. This chapter presents several techniques for the management of the fibrin sheath—the traditional catheter stripping technique, the internal catheter stripping technique, and the fibrin sheath angioplasty technique.