title: Subcutaneous pathway diversion for peritoneal dialysis catheter salvage.
abstract: Peritoneal dialysis (PD) catheter-related infection is still is the most troublesome problem for continuation of PD without the need to switch to hemodialysis. We have been performing subcutaneous pathway diversion (SPD) as a surgical treatment for refractory exit-site and tunnel infection (ESTI). To clarify the efficacy and safety of SPD, we conducted a retrospective study. From August 2008 to August 2013, 30 SPDs were performed in 26 patients (16 men, 10 women; mean age: 58 +/- 13 years; 54% with diabetes; mean body mass index: 23.9 +/- 3.5 kg/ m2). The reasons for the SPDs were ESTI in 25 patients, and outer cuff extrusion in 1 patient. All patients resumed PD immediately after SPD, and the duration of hospitalization was 11.7 +/- 10.1 days. After SPD, one patient experienced a dialysate leak, and another patient experienced a mild subcutaneous hematoma. Another 4 patients developed exit-site infection (ESI) and underwent a second SPD. Of those 4 patients, 3 presented with another ESI unrelated to the first episode, and all developed an ESI after 6 months or more. The remaining 20 patients experienced no such complications. Furthermore, catheter survival after SPD was 17.4 +/- 13.4 months. To eradicate ESTTI we suggest that SPD, which does not require catheter removal or interruption of PD, is useful compared with the unroofing technique or catheter removal.
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Sakurada
authors.forename: Takeshi
authors.initials: T
authors.lastname: Okamoto
authors.forename: Daisuke
authors.initials: D
authors.lastname: Oishi
authors.forename: Kenichiro
authors.initials: K
authors.lastname: Koitabashi
authors.forename: Shina
authors.initials: S
authors.lastname: Sueki
authors.forename: Nagayuki
authors.initials: N
authors.lastname: Kaneshiro
authors.forename: Katsuomi
authors.initials: K
authors.lastname: Matsui
authors.forename: Ryuto
authors.initials: R
authors.lastname: Nakazawa
authors.forename: Maki
authors.initials: M
authors.lastname: Yoshioka
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Konno
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Sato
authors.forename: Yugo
authors.initials: Y
authors.lastname: Shibagaki
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Chikaraishi
authors.forename: Kenjiro
authors.initials: K
authors.lastname: Kimura
mesh_terms: D000328:Adult; D000368:Aged; D055499:Catheter-Related Infections / Q000628:therapy*; D002404:Catheterization / Q000379:methods*; D002408:Catheters, Indwelling; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods; D040521:Subcutaneous Tissue; D016896:Treatment Outcome