EURORAD ESR

Case 536

Percutaneous removal of a fibrin sheath from a permanent dialysis catheter

Author(s)
D. Vorwerk, F. Poretti
 
Patient
female, 62 year(s)
 
 
  • Figure 1
    Fibrin sheath formation around a dialysis catheter
     

    DSA shows a patent dialysis catheter with a rim-like layer of contrats media around the catheter tip indicating fibrin sheath formation.

     
    Area of Interest: unknown; Imaging Technique: Fibrin sheath formation around a dialysis catheter;

    Plain image states that this rim-like enhancement is stable after the injection has stopped

     
    Area of Interest: unknown; Imaging Technique: Fibrin sheath formation around a dialysis catheter;

    Digital cavography of the superior vena cava exludes formation of a larger thrombus mass around the tip of the dialysis catheter. Small thrombus is not completely excluded by single plane cavography, but would be of...

     
    Area of Interest: unknown; Imaging Technique: Fibrin sheath formation around a dialysis catheter;
     
     
  • Figure 2
    Mechanical peeling of the dialysis catheter
     

    A hydrophilic guidewire has been advanced through the dialysis catheter into the inferior vena cava where the distal end is snared with use of a nitinol goose neck snare

     
    Area of Interest: unknown; Imaging Technique: Mechanical peeling of the dialysis catheter;

    The guidewire is retrieved while advancing the snare until the end of the dialysis catheter is reached

     
    Area of Interest: unknown; Imaging Technique: Mechanical peeling of the dialysis catheter;

    The snare is opened and advanced over the catheter.Then the snare is closed around the catheter and pulled down. This step is repeated for three times.

     
    Area of Interest: unknown; Imaging Technique: Mechanical peeling of the dialysis catheter;

    Control angiography via the dialysis catheter proves that the fibrin sheath has gone; aspiration is again possible

     
    Area of Interest: unknown; Imaging Technique: Mechanical peeling of the dialysis catheter;
     
     
DSA shows a patent dialysis catheter with a rim-like layer of contrats media around the catheter tip indicating fibrin sheath formation.
 
Plain image states that this rim-like enhancement is stable after the injection has stopped
 
Digital cavography of the superior vena cava exludes formation of a larger thrombus mass around the tip of the dialysis catheter. Small thrombus is not completely excluded by single plane cavography, but would be of minor clinical importance.
 
A hydrophilic guidewire has been advanced through the dialysis catheter into the inferior vena cava where the distal end is snared with use of a nitinol goose neck snare
 
The guidewire is retrieved while advancing the snare until the end of the dialysis catheter is reached
 
The snare is opened and advanced over the catheter.Then the snare is closed around the catheter and pulled down. This step is repeated for three times.
 
Control angiography via the dialysis catheter proves that the fibrin sheath has gone; aspiration is again possible
 
 
 
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