The fibroblastic sleeve, the neglected complication of venous access devices: A narrative review

Abstract

The presence of a vascular access device (or of any intravascular foreign body) inside the bloodstream is often associated with the formation of a connective tissue sleeve around the catheter (often named—erroneously—“fibrin sleeve”). Such sleeve is usually a physiological phenomenon with little or no clinical relevance, but its pathogenesis is still unclear, so that it is frequently confused with venous thrombosis; also, its relationship with other major catheter-related complications, such as venous thrombosis and bloodstream infection, is uncertain. This narrative review tries to convey in a systematic form the current knowledge about pathogenesis, incidence, clinical manifestations, diagnosis, and management of this phenomenon.

A prospective sonographic evaluation of peripheral intravenous catheter associated thrombophlebitis

“…Furthermore, recent investigations in central venous catheters (CVC) suggest that in some cases the peri-catheter thrombosis represents fibroblastic sleeve (FS) formation rather than traditional catheter-related thrombus. 30,31 FS is generally considered a benign and insignificant clinical finding in CVCs that occurs at a higher frequency than catheter-related thrombus. 31 In this study, we did not specifically differentiate between peri-catheter thrombus and FS formation, so any FS formation that may have occurred was inadvertently characterized as true thrombus.…”

“…30,31 FS is generally considered a benign and insignificant clinical finding in CVCs that occurs at a higher frequency than catheter-related thrombus. 31 In this study, we did not specifically differentiate between peri-catheter thrombus and FS formation, so any FS formation that may have occurred was inadvertently characterized as true thrombus. Given that both the quantity and location of thrombus did not impact progression to thrombophlebitis in our study population, even if a moderate proportion of peri-catheter thrombus represented FS, the clinical significance of this finding in short peripheral catheters remains unclear and needs further investigation.…”

Infected Retained Catheter-Related Sheath, an Underrecognized Complication of Central Venous Catheter Insertion: A Case Report

“…They can form on the outside of an implanted catheter as quickly as within 24 h. They are initially composed of a film of fibrin, laminin, collagen, fibronectin, and immunoglobulins and evolve over time to contain smooth muscle cells. These sheaths have been proposed as a cause for indwelling catheter dysfunction and can serve as a potential nidus for infection [ 4 ]. When the catheter is removed, there is potential for this sheath to be left in the vessel [ 5 ].…”

The Ghosts of Cannulae Past

“…Fibrin casts are not unique to ECMO cannulae and can be associated with the routine placement of central lines, with implanted cardiac devices (and subsequently noted after removal), and with larger-bore interventional radiology-associated catheters. 10 Because of the size of ECMO cannulae, it is unclear if associated fibrin casts pose a higher risk of complications and what the potential impact is on subsequent vascular access and mechanical circulatory support. Currently, suction thrombectomy systems, such as AngioVac Ò (AngioDynamics, Latham, NY) (which can be deployed through an ECMO circuit), and rheolytic thrombectomy with AngioJet TM (Boston Scientific, Marlborough, MA), are available for addressing this phenomenon should it be indicated for subsequent vascular access.…”

“…Reports of the calcification of fibrin sheaths are present in the literature, but the implications are unclear. 10 ECMO cannula-associated fibrin sheaths likely are more impactful than fibrin sheaths associated with vascular catheters because of their size, which could impose significant limitations on subsequent vascular cannulation attempts. Immediate complications related to ECMO-related fibrin sheaths include limitation on future vascular access sites, the risk of embolization, the risk of infection, and the complications of anticoagulation and procedures to address these fibrin sheaths should they be attempted.…”