Date of Award

January 2011

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Michael Tal

Subject Area(s)

Medicine

Abstract

This study compares the rates of central venous stenosis in patients undergoing hemodialysis who underwent disruption of fibrin sheath with percutaneous transluminal angioplasty (PTA) balloons and those who underwent over the wire catheter exchange.

This study is a retrospective review of 209 PTA balloon disruption and 1,304 over the wire catheter exchange procedures. Approval from the Human Investigations Committee was obtained for this study. Up to ten year follow up was performed. A χ2 test was used to compare the rates of central venous stenosis after balloon disruption versus catheter exchange. A T-test was used to compare time to central venous stenosis development.

Of the 753 patients in the study, 127 patients underwent balloon disruption of fibrin sheath and 626 had catheter exchange. Within the balloon disruption group, 18/127 patients (14.2%) subsequently developed central venous stenosis, compared with 44/626 (7.0%) in the catheter exchange group (P<0.01, χ2 test). Time to central venous stenosis development was approximately 3 years in both groups and not significantly different (1,371 and 1,010 days, P=0.20). Twenty five point two percent of patients in the balloon disruption group had 4 or more subsequent catheter exchanges versus 12.6% in the catheter exchange group (P<0.01, χ2 test).

There is a possible association between PTA balloon disruption of fibrin sheath and late onset central venous stenosis. Since venography was not routinely performed in catheter exchange patients, future randomized studies are necessary to confirm these findings.

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