Abstract: Objective To search for a new management technique to treat fibrin sheaths in tunneled dialysis catheters for the improvement of blood flow during hemodialysis. Methods We studied six maintenance hemodialysis patients, who were unable to create an arteriovenous fistula and had the history of central venous indwelling catheterizations at multiple sites. Digital subtraction angiography (DSA) confirmed the fibrin sheath formation in catheters. Percutaneous transluminal angioplasty (PTA) was then performed to disrupt the catheter sheath, followed by placement of an indwelling cuff-tunneled catheter via an internal jugular or femoral vein after successful angioplasty. Results The new catheters functioned well (blood flow rate >250 ml/ min) during hemodialysis in 5 cases, and the catheter could provide a blood flow of 220 ml/min in the second hemodialysis session in one case. No catheter dysfunction and infection were found in these cases in the following- up period of 2～6 months. Conclusion Balloon angioplasty to disrupt fibrin sheaths improved the patency of catheters and increased the blood flow during hemodialysis.

Key words: hemodialysis, blood access, tunneled catheter, fibrin sheath, interventional treatment