Abstract: 【Abstract】Objective To search for a new technique for the management of fibrin sheath in order to improve the treatment of catheter dysfunction in hemodialysis patients. Methods A retrospective analysis was conducted for the 40 hemodialysis patients who failed to establish arteriovenous fistula and underwent indwelling tunneled dialysis catheterization. They had catheter related fibrin sheath and fibrin sheath crevasse confirmed by DSA images that showed outflow of contrast through the fibrous sheath crevasse with normal images of brachiocephalic vein and/or superior vena cava. Catheters were inserted into right atrium via central vein through the fibrin sheath crevasse to avoid wrapping of the catheter by the fibrin sheath in 18 patients, and by means of in situ catheter change in 22 patients. Results After the catheter intervention, the catheters were used for blood access on the next day in both groups and the blood flow reached 250ml/min. After 3 months, the blood access volumes of the two groups were (241±2.92) ml/min and (240±4.18)ml/min, respectively,
and the Kt/V values were (1.3±0.05 vs. 1.28±0.04), respectively, without statistical differences between the two groups (P=0.420). After 6 months, blood access volumes in in situ catheter change group and in catheter replacement through fibrous sheath crevasse group were (202±3.74) ml/min and (240±4.47) ml/min, respectively (P=0.020), and Kt/V values were (1.04±0.04) and 1.28±0.03, respectively (P=0.010). No severe complications due to the catheter replacement occurred in all patients. Conclusion Dialysis catheter implantation through fibrous sheath crevasse can safely and effectively correct the dysfunction of dialysis catheter.

Key words: Hemodialysis, Blood access, Tunneled catheter, Fibrin sheath, Interventional treatment