Minimally invasive fluoroscopic percutaneous peritoneal dialysis catheter salvage

Abstract

BackgroundPeritoneal dialysis catheter (PDC) dysfunction can often be treated fluoroscopically by manipulation with wire, balloon or stiff stylet, saving surgical intervention for refractory cases. We describe an enhanced percutaneous approach to PDC salvage that can lead to a more definitive intervention and salvage for cases refractory to fluoroscopic manipulation.MethodsIn five cases of PD catheter malfunction, the deep cuff was dissected free after a 0.035 hydrophilic wire was passed into the peritoneum through the PDC. Only the intraperitoneal portion of the PDC was explanted. The PDC was cleared of obstruction and omentum. The intraperitoneal portion of the PDC was reimplanted over wire via a peel-away sheath and the deep cuff sutured.ResultsOmental entrapment was present in three of five patients and fibrin occlusion in four of the five cases. All catheters were repaired successfully by the described technique. Post procedure, 3–5 days of lower volume, recumbent PD exchanges were performed prior to full-dose PD. No perioperative complications or leaks were noted. All PDCs were patent at 6 months. One patient required laparoscopy for recurrent omental wrapping 3 months post intervention.ConclusionsPDC salvage in this manner is a cost-effective alternative to laparoscopic repair of PDCs failing catheter manipulation. The infection barrier afforded by the original superficial cuff and subcutaneous tunnel is maintained. PD can be resumed immediately. Only refractory cases need laparoscopy. This procedure allows for a more definitive correction of catheter migration and obstruction, avoids placement of a new PDC or temporary hemodialysis, is cost-effective and expands percutaneous options for dysfunctional PD catheters.

Peritoneal Dialysis

“…Management of PD catheter dysfunction due to migration, fibrin plugging, or omental wrapping can be attempted via a percutaneous fluoroscopic-guided approach offering PD salvage at a lower cost than surgical interventions, while also avoiding general anesthesia. 6 These advantages suggest radiologic treatment of malfunctioning catheters as a primary step, with more invasive surgical options performed if less invasive means are unsuccessful.…”

Procedimientos en cirugía: Colocación percutánea del catéter de diálisis peritoneal

“…Un drenaje inadecuado del líquido de diálisis peritoneal podrá deberse a varias razones: coágulos o fibrina dentro del catéter, obstrucción por adhesión del epiplón o por las mismas asas intestinales formando adherencias [30]. En los casos anteriores podrá tratar de rescatar el catéter con una irrigación forzada con solución salina a presión y si está disponible se podrá utilizar uroquinasa (100,000 UI; 5 ml durante 1 hr).…”