Balloon angioplasty vs wire disruption as therapy for dysfunctional hemodialysis catheters due to fibrin sheath

Purpose A common cause of tunneled hemodialysis catheter dysfunction is the formation of a fibrin sheath. Dysfunctional catheters unresponsive to conservative management options often require guidewire catheter exchange and fibrin sheath disruption. There are multiple reported techniques for fibrin sheath disruption however there is no reliable evidence to support whether one technique is superior over any another. The purpose of this study is to prospectively compare two different methods of catheter sheath disruption: balloon angioplasty versus wire disruption. Materials and Methods We designed a prospective randomized control study comparing two different methods of hemodialysis catheter fibrin sheath disruption. Subjects with dysfunctional hemodialysis catheters requiring guidewire catheter exchange from January 2009 to June 2012 were included in the study. Subjects with the presence of a fibrin sheath at the time of catheter exchange were randomized to have the sheath disrupted by one of two methods: balloon angioplasty or wire disruption. Subjects without evidence of a fibrin sheath at the time of catheter exchange were used as a control. Patients were followed for a minimum of six months to determine the time to repeat catheter dysfunction, time to repeat catheter exchange, mean blood flow during hemodialysis treatment, and adverse events. Results Pending (late-breaking abstract). Conclusion Pending (late-breaking abstract).