Abstract
Interventional radiology (IR) is an underutilized resource for the placement and management of tunneled peritoneal dialysis (PD) catheters, as only about 5% of PD catheters are placed by using IR. PD is a cost-effective and physiologically beneficial alternative to hemodialysis (HD) with an increased survival benefit and lower complication rate than HD. As a home dialysis therapy, patients who undergo PD experience many advantages over patients who undergo HD, including a greater sense of well-being and quality of life. The author explains the history, need, rationale, benefits, complications, patient selection, preprocedure patient evaluation and preparation, catheter selection, procedural directives, and management strategies of IR involvement in tunneled PD catheter placement. Surgical and non-image-guided placement techniques and pitfalls are also discussed, and their benefits and limitations are compared with the cost-effective percutaneous image-guided IR technique. Specific attention to image-documented placement of the PD catheter coil into the retrovesical or retrouterine space is emphasized for optimal PD catheter function, as the retrovesical or retrouterine space is the most dependent portion of the peritoneal space and is void of omentum and small bowel. These features increase the functional ability of the PD catheter to effectively exchange the dialysate fluid and avoid complications such as omental wrap. IR, as an image-based specialty, is well positioned to evaluate for other complications of tunneled PD catheters such as migration, catheter kink and obstruction, and catheter leak. The demand for PD is predicted to increase in the future, and IR is strategically situated to become a leader in tunneled PD catheter placement and management. Published under a CC BY 4.0 license.
Highlights
Peritoneal dialysis (PD) is a low-cost and physiologically beneficial option for many patients with end-stage renal disease (ESRD) [1,2]
Preoperative evaluation of each patient, usually performed by a dedicated peritoneal dialysis management team, is essential for long-term success. This assessment should include the determination of the optimal PD catheter exit site, which should be marked on the skin with indelible ink
The percentage of all patients with ESRD utilizing PD has recently decreased in the United States, as 9.7% of patients with established ESRD were being treated with PD in 2014, whereas only 7.1% were receiving PD on December 31, 2017, which represents a total of 53 006 patients [20,25]
Summary
Peritoneal dialysis (PD) is a low-cost and physiologically beneficial option for many patients with end-stage renal disease (ESRD) [1,2]. Patients who undergo PD experience a greater sense of well-being, an improved steady state in terms of hemodynamics and extracellular fluid volume shifts, maintenance of residual renal function, and lower complication rates compared with those undergoing hemodialysis (HD) [3,4,5,6,7,8,9]. A survival benefit of PD over HD has been shown in patients younger than 65 years [17]. PD is a home dialysis therapy, which is associated with greater patient independence and improved quality of life [18,19,20]. PD differs from HD in that no artificial membrane for extracorporeal hemodiffusion or hemofiltration is used, as the patient’s visceral and parietal peritoneum serves as the semipermeable membrane needed to exchange between the extracellular fluid
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