title: Minimally invasive fluoroscopic percutaneous peritoneal dialysis catheter salvage.
abstract: BACKGROUND
  Peritoneal 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.
  
  
  METHODS
  In 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.
  
  
  RESULTS
  Omental 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.
  
  
  CONCLUSIONS
  PDC 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.
authors: Clinical and Interventional Nephrology , San Antonio Kidney Disease Center , San Antonio, TX , USA.
authors: Rajeev
authors: R
authors: Narayan
authors: Clinical Nephrology, San Antonio Kidney Disease Center , University of Texas Health Science Center at San Antonio , San Antonio, TX , USA.
authors: Terrance
authors: T
authors: Fried
authors: Clinical and Interventional Nephrology , San Antonio Kidney Disease Center , San Antonio, TX , USA.
authors: Gerardo
authors: G
authors: Chica
authors: Clinical and Interventional Nephrology , San Antonio Kidney Disease Center , San Antonio, TX , USA.
authors: Mathew
authors: M
authors: Schaefer
authors: Clinical and Interventional Nephrology , San Antonio Kidney Disease Center , San Antonio, TX , USA.
authors: Daniel
authors: D
authors: Mullins
keywords: catheter dysfunction; catheter migration; fluoroscopy; peritoneal dialysis catheter; peritoneal dialysis catheter salvage