title: Fluoroscopically-guided manipulation of malfunctioning peritoneal dialysis catheters.
abstract: OBJECTIVE
  To review our experience with fluoroscopic evaluation and manipulation of malpositioned, malfunctioning, peritoneal dialysis (PD) catheters.
  
  
  METHODS
  Thirty-one patients, over a 5-year period (1 May 1992 to 30 April 1997) with malfunctioning PD catheters, who had fluoroscopically-guided manipulation were reviewed. Catheters were manipulated using a malleable aluminum bar and, if necessary, guide wires or other stiffeners. Technical success was assessed on the basis of adequate, fluoroscopically verified, catheter placement at the time of the procedure and improved flows. A functional PD catheter at 30 days post manipulation was considered to be a clinically successful manipulation.
  
  
  RESULTS
  There were 41 manipulations [33 initial (IM) and 8 remanipulations (RM)] for malpositioned or kinked catheters. In 31 (19 male, 12 female) patients ranging in age from 31 to 76 years (mean age 60 years), the initial technical success rate was 85% for IM (n = 28/33) and 63% (n = 5/8) for RM. The overall clinical success rate, or 30-day primary patency, was 55% for IM (n = 18/33) and 63% for RM. Catheter function (combined IM and RM) continued for a median 869 days (95% CI: 118, 1620). No early complications were noted.
  
  
  CONCLUSIONS
  Fluoroscopic manipulation, including attempts at remanipulation, of PD catheters is a safe procedure. The technique is a simple, inexpensive, and effective way of prolonging PD catheter life, thereby reducing the number of surgical interventions.
authors.affiliation: Department of Medical Imaging, Toronto Hospital (Western Division), University of Toronto, Ontario, Canada.
authors.forename: M E
authors.initials: ME
authors.lastname: Simons
authors.forename: G
authors.initials: G
authors.lastname: Pron
authors.forename: M
authors.initials: M
authors.lastname: Voros
authors.forename: L C
authors.initials: LC
authors.lastname: Vanderburgh
authors.forename: P S
authors.initials: PS
authors.lastname: Rao
authors.forename: D G
authors.initials: DG
authors.lastname: Oreopoulos
mesh_terms: D000328:Adult; D000368:Aged; D000535:Aluminum; D002404:Catheterization / Q000295:instrumentation; D002408:Catheters, Indwelling; D004868:Equipment Failure; D005260:Female; D005471:Fluoroscopy; D005500:Follow-Up Studies; D005548:Foreign-Body Migration / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000295:instrumentation*; D015641:Radiography, Interventional; D019233:Retreatment; D012189:Retrospective Studies; D012212:Rheology; D016896:Treatment Outcome
chemical_list: D000535:Aluminum