STRIPPING OF FAILING HEMODIALYSIS CATHETERS USING THE AMPLTAZ GOOSENECK SNARE

The development of a fibrin sheath at the tip of a long-term haemodial ysis catheter mag lead to deteriorating blood flow rates, resulting in inadequate haemodialysis. Restoration of functional patency has been described using the technique of percutaneous fibrin sheath stripping (PFSS) using a wire snare de rice. Our purpose was to assess this tech nique within an established renal vascular access ser, ice. All cathet ers referred for the assessment of low blood flow rates on dialysis we re considered for the procedure. Initial fluoroscopic assessment of th e catheter was followed by stripping of the tip of the catheter using a gooseneck snare, Seventeen of 22 well-positioned catheters undergoin g a single PFSS attempt were restored to function with a median prolon gation of patency of 1.25 months, Two catheters underwent a second PFS S procedure providing additional patency. Nineteen of a total of 24 (7 9%) PFSS procedures successfully restored catheter function, Seven cat heters with poorly positioned tips or a kink were not restored to func tional patency using PFSS, Two patients developed a puncture site haem atoma, No patient developed symptoms of pulmonary emoblism, In conclus ion, PFSS restored function in 79% of attempts in well positioned cath eters, The method is technically straightforward, with a low complicat ion rate and has become a routine part of the renal vascular access se rvice.