title: Efficacy and safety of fluoroscopic manipulation using the alpha-replacer for peritoneal catheter malposition.
abstract: BACKGROUND
  Catheter malposition is one of the reasons for outflow failure in peritoneal dialysis (PD) patients. Fluoroscopic manipulation is a non-surgical treatment option for catheter malposition. We retrospectively analyzed the efficacy and safety of fluoroscopic manipulation using an alpha-replacer guidewire.
  
  
  METHODS
  The alpha-replacer (JMS Co. Ltd., Tokyo, Japan) is a guidewire for the treatment of catheter malposition. We used the alpha-replacer in 23 PD cases at our hospital from January 2008 to December 2012. We evaluated body mass index, time interval between catheter placement and malposition, and interval between catheter exteriorization and malposition. Primary failure was defined as malposition at the time of catheter exteriorization, and secondary failure as malposition after functional PD therapy (correct position at time of exteriorization).
  
  
  RESULTS
  Successful catheter replacement rate using the alpha-replacer was 60.8 % (14 of 23 cases). This was similar to the rates in previous reports. Successful replacement was mostly observed in those with a long interval between catheter placement and malposition (p = 0.048), between catheter placement and exteriorization (p = 0.047) and with secondary failure (p = 0.030). In multivariate analysis, secondary failure cases had a higher rate of successful replacement than primary failure cases (odds ratio [OR] 7.33, p = 0.038). Serious complications, such as abdominal trauma or peritonitis, were not observed.
  
  
  CONCLUSIONS
  Fluoroscopic manipulation using an alpha-replacer may be safe and effective for the management of peritoneal catheter malposition, particularly in patients who were under functional PD therapy until catheter malposition.
authors.affiliation: Department of Internal Medicine, Kasugai Municipal Hospital, 1-1-1 Takakicho, Kasugai, 486-8510, Aichi, Japan. yosukesaka@hospital.kasugai.aichi.jp.
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Saka
authors.affiliation: Department of Nephrology, Nagoya University Graduate School of Medicine, Showaku, Nagoya, Aichi, Japan.
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Ito
authors.affiliation: Department of Nephrology, Yokkaichi Municipal Hospital, Yokkaichi, Mie, Japan.
authors.forename: Yoshiyasu
authors.initials: Y
authors.lastname: Iida
authors.affiliation: Department of Nephrology, Nagoya University Graduate School of Medicine, Showaku, Nagoya, Aichi, Japan.
authors.forename: Shoichi
authors.initials: S
authors.lastname: Maruyama
authors.affiliation: Department of Nephrology, Nagoya University Graduate School of Medicine, Showaku, Nagoya, Aichi, Japan.
authors.forename: Seiichi
authors.initials: S
authors.lastname: Matsuo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002404:Catheterization / Q000295:instrumentation / Q000379:methods*; D002408:Catheters, Indwelling / Q000009:adverse effects*; D004868:Equipment Failure; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010529:Peritoneal Cavity; D010530:Peritoneal Dialysis / Q000009:adverse effects / Q000295:instrumentation*; D011860:Radiography, Abdominal; D015641:Radiography, Interventional; D012189:Retrospective Studies
keywords: Alpha-replacer; Catheter malposition; Peritoneal dialysis