CC BY-NC-ND 4.0 · The Arab Journal of Interventional Radiology 2018; 02(03): S11
DOI: 10.1055/s-0041-1730676
Abstract

Percutaneous Image-Guided Peritoneal Dialysis Catheter Insertion: Retrospective Review of 58 Patients

Mohammad Arabi
King Abdulaziz Medical City, Riyadh, Saudi Arabia
,
Sultan Alammari
King Abdulaziz Medical City, Riyadh, Saudi Arabia
,
Shahbaz Qazi
King Abdulaziz Medical City, Riyadh, Saudi Arabia
,
Omar Bashir
King Abdulaziz Medical City, Riyadh, Saudi Arabia
,
Refaat Salman
King Abdulaziz Medical City, Riyadh, Saudi Arabia
,
Yousof Alzahrani
King Abdulaziz Medical City, Riyadh, Saudi Arabia
› Author Affiliations

Background: This study aimed to retrospectively evaluate the short-term outcomes of image-guided percutaneous peritoneal dialysis (PD) catheter insertion. Methods: From August 2015 to October 2017, a total of 58 consecutive patients (29 males), with a mean age of 47.7 years (15–96 years), underwent percutaneous PD catheter insertion. Peritoneal catheter was the initial method of dialysis in 48 patients (83%), while 9 (17%) patients were on regular hemodialysis and 1 patient had a history of PD through a surgically placed catheter. Dwelling time was defined as the time from insertion to the last clinical follow-up or catheter removal. Procedure- and catheter-related complications were recorded. Results: Catheter insertion was successful in 57 patients (98%). One procedure was initially aborted after inferior epigastric artery injury that resulted in pseudoaneurysm requiring thrombin injection. This patient underwent uneventful catheter insertion on the other side few days later, rendering the overall technical success of 100%. Another patient had procedure-related peritonitis 48 h following the initial insertion and was treated by antibiotics and catheter exchange. Dialysis was successfully initiated in 55 patients (94%) and failed in the remaining 3 patients due to persistent blockage from previous PD-related adhesions (n = 1), large seminal vesicle cysts occupying the pelvis (Zinner syndrome) (n = 1), and one patient remained on hemodialysis. During a mean dwelling time of 299 days (21–819 days), dialysis remains ongoing in 32 patients (55%). A total of 23 catheters were removed during the mean time of 170 days (12–699 days) as follows: postrenal transplant (n = 9), patient's preference for hemodialysis (n = 4), peritonitis (n = 5), need for high-rate hemodialysis (n = 1), pleuroperitoneal connection (n = 1), leak (n = 1), wound infection (n = 1), and persistent blockage (n = 1). Catheter dysfunction due to blockage or tip migration occurred in 13% (8/58), with subsequent relapsing peritonitis necessitating catheter removal in five patients despite repeated manipulation and exchange. Two patients (2/8) had successful manipulation using a stiff wire with ongoing dialysis and one patient died from other comorbidities. Catheter-related peritonitis occurred in 26% (15/58) of patients, which was managed by antibiotics in 9 cases with ongoing dialysis at last follow-up and catheter removal in 5 patients. One catheter was complicated by the overlying skin necrosis due to excessive weight loss after insertion, which was managed by skin closure with sutures. One patient had tiny small bowel perforation during wire manipulation of malpositioned catheter, which was treated with antibiotics with no consequences. Two patients died during the follow-up time due to worsening comorbidities. Conclusion: Percutaneous image-guided placement of PD catheter is an effective minimally invasive technique. Proper catheter maintenance is essential to prevent catheter dysfunction and peritonitis, which represent the most frequent complications.



Publication History

Article published online:
11 May 2021

© 2018. The Arab Journal of Interventional Radiology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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