Interventional radiology placement and management of tunneled peritoneal dialysis cathe-ters: A pictorial review

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 omen-tum 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 obstruc-tion, 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.