Dialysis Catheter with Fibrin Sheath Maceration

Middle aged patient on renal dialysis for chronic renal insufficiency, has complaints of poor flow through a left IJ permanent dialysis catheter.

Examination of the catheter under fluoroscopy showed the catheter to be in good position with the tips of the catheter in the right atrium. Injection of contrast, as shown above, demonstrates flow of contrast into the atrial lumen. Contrast also "backtracks" along the outer surface of the catheter, indicating a fibrin sheath.

The catheter was removed over a wire. An angioplasty balloon was advanced over the wire into the right atrium and inflated. The balloon was run along the course of the wire from right atrium to the left brachiocephaic vein. The fibrin sheath was macerated.

 

A new dialyis catheter was placed. Injection of contrast through the new catheter shows no backtracking of contrast. Flows through the new caheter were improved with dialysis.