Case review and imaging: Treatment of central venous catheter associated fibrin sheath and chronic thrombus with the ClotTriever system.

病例回顾和影像学 ： 使用 ClotTriever 系统治疗中心静脉导管相关的纤维蛋白鞘和慢性血栓。

• 发表时间: 2024 Feb
• 来源期刊: Radiol Case Rep
• DOI: 10.1016/j.radcr.2023.10.062
• PMID: 38074433
• 文章类型: Case Reports
• 作者列表: Tomaszek K,Rahman F

关键词: Catheter obstruction; Central venous catheterization; ClotTriever System; Dialysis catheter malfunction; Fibrin sheath; Superior vena cava syndrome

Abstract

Fibrin sheath formation is a leading culprit of central venous catheter malfunction. The complete removal of fibrin sheaths is an essential component of maintaining catheter patency, preventing future restenosis, and decreasing the risk of bloodborne infections. Treatment of fibrin sheaths includes pharmacologic therapy, balloon angioplasty, catheter exchange, and mechanical stripping. In this article 3 cases are reviewed, 2 patients had long-term hemodialysis catheter malfunction and 1 had complications related to a chest port. On imaging, superior vena cava stenosis, occlusion, and/or filling defect were identified for all patients, as well as findings suggesting the presence of fibrin sheath. Description of these cases detail a new technique for fibrin sheath removal utilizing the ClotTriever System (Inari Medical, Irvine, CA), which is a mechanical thrombectomy device used for the treatment of deep vein thrombosis. This technique allowed for complete removal of the fibrin sheath via a minimally invasive interventional procedure which did not require access through the central venous catheter lumen.

摘要

纤维蛋白鞘形成是中心静脉导管故障的罪魁祸首。完全去除纤维蛋白鞘是维持导管通畅的重要组成部分，防止未来再狭窄，降低血源性感染的风险。纤维蛋白鞘的治疗包括药物治疗，球囊血管成形术,导管交换,和机械剥离。本文回顾了3个案例，2例患者有长期血液透析导管故障，1例患者有与胸口相关的并发症。在成像方面，上腔静脉狭窄,遮挡,和/或所有患者的填充缺陷均已确定，以及表明存在纤维蛋白鞘的发现。这些病例的描述详细介绍了一种利用ClotTriever系统去除纤维蛋白鞘的新技术（InariMedical，Irvine,CA),这是一种用于治疗深静脉血栓的机械血栓切除装置。该技术允许通过微创介入程序完全去除纤维蛋白鞘，该程序不需要通过中心静脉导管腔进入。