SONOGRAPHIC AND FLUOROSCOPIC PERITONEAL DIALYSIS CATHATER PLACEMENT, POST PROCEDURAL OUTCOMES  

Purpose: Peritoneal dialysis (PD) cathaters may be inserted surgically, blindly or  by fluoroscopic approach. Adding ultrasound-assistance  to fluoroscopic technique ensures entry into abdominal cavity under direct ultrasound visualization. In this way, complications such as intestinal perforation due to puncture or damage to the superficial epigastric vessels can be significantly prevented. The aim of our study is to share our case series in which we reveal our peritoneal dialysis catheter placement technique and catheter-related complications in the post-procedure period. 

Materials and methods: In this single center study, from May 2021 to August 2023 ultrasound-fluoroscopic guided placement of PD catheters was attempted in 33 end-stage renal disease (ESRD) patients. Preoperative evaluation was performed on all patients prior to the procedure and patients are reviewed retrospectively. Two patients were started on acute peritoneal dialysis the same day of catheter placement without any complications. The rest of the patients started peritoneal dialysis within two months of catheter placement. Short-term outcomes and complications related to treatment termination were followed. 

Results: A total of 33 adult patients (19 women, 14 men; mean age 63) were reviewed. No complications were observed during the procedure in any patient. In terms of short term outcomes, catheter herniation into inguinal hernia was observed in one patient (3%), hemodialysis fluid leakage to pelvic area in two patients (6%), and catheter malfunction  in one patient (3%). While the patient with herniation could continue his treatment in the next period, treatment was terminated in patients with catheter malfunction and hemodialysis fluid leakage. Apart from these, one patient whose catheter function was not impaired, died due to malignancy. 

Conclusion: The ultrasound-assistance  to fluoroscopic technique seems to be safe and effective. The short-term complication rates are encouraging; however, these results need to be validated on long-term follow-up studies.