The fibrin sheath after dialysis catheter removal or the “ghost” catheter - what a surgeon, nephrologist and cardiologist needs to know?

Despite the obvious advantages of an arteriovenous fistula, the tunneled central venous catheter (tCVC) remains a first-line vascular access in a significant number of incident patients. The formation of a fibrin sheath (FS) around the intravascular segment of the dialysis catheter is a consequence of the pathophysiological interactions of the abiotic artificial structure with the venous endothelium and blood cells. In some cases, FS remains in the central vein lumen after removal of the dialysis catheter, mimicking the structure and contour of the fragment of the extracted tCVC (“ghost” catheter). FS of the removed tCVC is usually asymptomatic, is an accidental diagnostic finding and does not require special medication or surgical intervention. Nevertheless, the contribution of the “ghost” catheter in the development of specific infectious and non-infectious complications seems to be underestimated. In particular, FS of the removed tCVC can become a nidus of the nonvalvular right-sided infective endocarditis or a source of thromboembolic complications. The article provides an overview of current state of the art regarding the morphology of FS, the optimal diagnostic modalities of it’s visualization, possible FS-associated complications and approaches to their treatment. The article is supplemented by own clinical observations and is addressed to a wide range of health professionals dealing with vascular access for maintenance hemodialysis.

сосудистый доступ, тоннелированный центральный венозный катетер, фибриновый капюшон, катетер-ассоциированная инфекция кровотока, неклапанный правосторонний инфекционный эндокардит, чреспищеводная эхокардиография, vascular access, tunneled central venous catheter, fibrin sheath, catheter-associated blood stream infection, nonvalvular right-sided infective endocarditis, transesophageal echocardiography

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