Intra-Arterial Fibrinous Sheath Development as a Potential Complication of the Impella Ventricular Assist Device

Fibrin Sheath Formation during Mechanical Circulatory Support

“…D iscontinuing mechanical circulatory support is often guided by transesophageal echocardiography (TEE). 1,2 TEE was used to guide removal of an bicaval duallumen catheter (Avalon Elite, Maquet, Rastatt, Germany) after recovery of lung function in a patient supported with venovenous extracorporeal membrane oxygenation. TEE assessment of the right atrium showed a large fibrin sheath after removal of the catheter (arrow on panel A; LA, left atrium; RA, right atrium).…”

“…Consequently, a fibrin sheath may form regardless of the degree of anticoagulation during mechanical circulatory support therapy, making routine TEE examination during mechanical circulatory support decannulation potentially important. 2 Treatment options for a catheter-related fibrin sheath depend on the size, location, and mobility of the fibrin sheath and include observation, anticoagulation or percutaneous or open surgical removal. 3…”